The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model

Abstract

Objective: To test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients. Methods: This was a cross-sectional study of 193 patients in an oncology unit. Outcome measures included perceived control, performance status, symptoms of depression, perceived dignity, and the WTHD. Structural equation modeling was performed. Results: The WTHD correlated significantly with perceived control (rs = -.216), performance status (rs = -.175), symptoms of depression (rs = .351), and perceived loss of dignity (rs = .308). Structural equation modeling showed that perceived loss of control (-.402) and functional impairment (-.21) were risk factors for perceived loss of dignity. Loss of control (-.385) and functional impairment (-.283) were also risk factors for symptoms of depression. Perceived loss of dignity and symptoms of depression were the most proximal determinants of the WTHD, on which they had a direct, positive, and significant effect (.246 and .209, respectively). Therefore, both symptoms of depression and perceived loss of dignity independently predicted the WTHD and mediated the effects of perceived loss of control and functional impairment on this wish. Conclusions: The hypothesized model provides evidence for the impact of the four aforementioned factors on the WTHD. Our results suggest that personalized care plans which are able to enhance the sense of dignity and control among advanced cancer patients could help to reduce the likelihood or intensity of a WTHD.