Evidence map›Paper›PMID 32299415›Full record

ArticleBMC palliative care2020

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

Kerstin Kremeike, Gerrit Frerich, Vanessa Romotzky, Kathleen Boström, Thomas Dojan, Maren Galushko, Kija Shah-Hosseini, Saskia Jünger, Gary Rodin, Holger Pfaff and 2 more

Abstract read
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In one paragraph

Article in BMC palliative care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Kerstin KremeikeDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany. kerstin.kremeike@uk-koeln.de.
Gerrit FrerichDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Vanessa RomotzkyDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Kathleen BoströmDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Thomas DojanDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Maren GalushkoDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Kija Shah-HosseiniInstitute of Medical Statistics and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany.
Saskia JüngerCologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), University of Cologne and University Hospital of Cologne, Cologne, Germany.
Gary RodinDepartment of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Holger PfaffInstitute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Medical Faculty, Cologne, Germany.
Klaus Maria PerrarDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Raymond VoltzDepartment of Palliative Medicine, Medical Faculty, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.

Funding

Bundesministerium für Bildung und Forschung 01GY1706
6 · The paper itself

Abstract

backgroundAlthough desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress.

methodsWithin a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria.

results11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die".

conclusionsWe have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts.

trial registrationThe study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

Indexed as

Attitude to DeathAgedAged, 80 and overDelphi TechniqueFemaleGermanyHumansMaleMiddle AgedPalliative CareQualitative ResearchSurveys and QuestionnairesTerminally IllConsensusDesire to dieGermanyPalliative carePatientsProfessionalsSuicidal ideation, relationship, communicationWish towards hastened death

Identifiers

PMID32299415
PMCPMC7164236

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.