Journal of palliative medicine · 2026
Wish to Hasten Death in Advanced Cancer Patients Receiving Palliative Care. A Cross-Sectional Study in a Latin American Setting.
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Mendiguren María Del Pilar, Iturri Agustina, De Antueno María Del Pilar, Najun Matias, Maluenda Martinez Maria, Gunning Mercedes, Macias Sol, Rufino María Lujan, Urdaiz Elena, Alcántar Hernández Carla Andrea, Quiroga Candela Ariadna Beatriz, Magneres Delfina, Monforte-Royo Cristina
Аннотация
BACKGROUND: The wish to hasten death (WTHD) is a recognized expression of suffering in advanced illness, yet remains systematically underexplored in Latin America, where data are virtually absent.
OBJECTIVES: To determine the prevalence of the WTHD, and identify associated factors and predictors in advanced cancer patients receiving palliative care in Argentina.
DESIGN: Cross-sectional descriptive study.
SETTING/SUBJECTS: One hundred consecutive patients with stage IV cancer under active palliative care follow-up at a university hospital in Argentina were enrolled between January 2024 and December 2025.
MEASUREMENTS: WTHD was assessed using the AFEDD interview; it was identified in 35% of patients based on a positive screening response with severity scores among these patients ranging from 2 to 7 (median = 5). Symptom burden was measured with the revised Edmonton Symptom Assessment System (ESAS-r); total scores were calculated both with and without the additional item "feeling like a burden to others." Demoralization was assessed using the Demoralization Scale-II (DS-II), with a cutoff score of ≥10.
RESULTS: WTHD was identified in 35% of patients that scored between 2 and 7 (median = 5). Among those, most scored at the lower end of the clinical continuum (⥶x), without active planning. Patients who scored high in WTHD (⥸ x) showed significantly higher symptom burden (median ESAS-r 41.0 vs. 31.0; p < 0.001) and demoralization rates (62.9% vs. 23.1%; p < 0.001). In multivariate logistic regression, demoralization was the only independent predictor of WTHD (OR = 6.56; 95% CI: 2.47-18.53; p < 0.001).
CONCLUSIONS: Demoralization is the key factor associated with the WTHD in this Latin American palliative care sample. Proactive, multidimensional assessment addressing meaning, dignity, and relational suffering is essential for comprehensive end-of-life care.
OBJECTIVES: To determine the prevalence of the WTHD, and identify associated factors and predictors in advanced cancer patients receiving palliative care in Argentina.
DESIGN: Cross-sectional descriptive study.
SETTING/SUBJECTS: One hundred consecutive patients with stage IV cancer under active palliative care follow-up at a university hospital in Argentina were enrolled between January 2024 and December 2025.
MEASUREMENTS: WTHD was assessed using the AFEDD interview; it was identified in 35% of patients based on a positive screening response with severity scores among these patients ranging from 2 to 7 (median = 5). Symptom burden was measured with the revised Edmonton Symptom Assessment System (ESAS-r); total scores were calculated both with and without the additional item "feeling like a burden to others." Demoralization was assessed using the Demoralization Scale-II (DS-II), with a cutoff score of ≥10.
RESULTS: WTHD was identified in 35% of patients that scored between 2 and 7 (median = 5). Among those, most scored at the lower end of the clinical continuum (⥶x), without active planning. Patients who scored high in WTHD (⥸ x) showed significantly higher symptom burden (median ESAS-r 41.0 vs. 31.0; p < 0.001) and demoralization rates (62.9% vs. 23.1%; p < 0.001). In multivariate logistic regression, demoralization was the only independent predictor of WTHD (OR = 6.56; 95% CI: 2.47-18.53; p < 0.001).
CONCLUSIONS: Demoralization is the key factor associated with the WTHD in this Latin American palliative care sample. Proactive, multidimensional assessment addressing meaning, dignity, and relational suffering is essential for comprehensive end-of-life care.