The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

Area of Science:

• Palliative Care Medicine
• Clinical Psychology
• Bioethics

Background:

• Desire to die is common in palliative care patients, yet therapeutic responses remain uncertain.
• A training program and clinical approach were developed to assist healthcare professionals.
• This study aimed to refine a clinical approach for addressing the desire to die and related distress.

Purpose of the Study:

• To revise and build consensus on a semi-structured clinical approach for managing patients' desire to die.
• To support proactive communication and routine exploration of death and dying distress.
• To integrate evidence, patient perspectives, and expert consensus into clinical practice.

Main Methods:

• A sequential mixed-methods design was employed.
• 16 palliative care patients participated in semi-structured interviews.
• A two-round Delphi process involved 377 international experts.

Main Results:

• Patient interviews highlighted the importance of professional-patient relationships, setting, and external support.
• Experts reached immediate consensus on nine domains of the clinical approach, including conversation design and recommended actions.
• Consensus on proactively addressing the desire to die was achieved in the second Delphi round.

Conclusions:

• The study presents the first semi-structured clinical approach for identifying, addressing, and therapeutically responding to the desire to die.
• This approach is grounded in evidence, patient views, and expert consensus.
• It provides a framework for healthcare professionals to navigate complex end-of-life conversations.