This study explores the complex intersection of euthanasia, legal ambiguities, cultural attitudes, and the psychology of suicide among seriously ill patients in China. It addresses the lack of clear ...legislation on euthanasia and doctor-assisted killing, the impact of cultural and philosophical beliefs, and the evolution of legal and ethical perspectives on suicide. Additionally, it examines the psychological aspects of suicide ideation in acutely-ill patients, focusing on factors like familial burden and loss of dignity.
A survey was conducted with 356 Chinese adults, aged 23 to 64 years, using popular social media platforms in China. The study aimed to reflect a broad spectrum of the adult population in terms of age, education, and professional sectors. The research model involves suicide rumination as an independent variable, acutely-ill patients' suicide acceptance as a dependent variable, and three mediators: cognitive depression, ethical suicide acceptance, and suicide legitimization.
The findings reveal a significant total effect of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance, underlining a robust direct relationship that supports Hypothesis 1. The analysis indicates that Suicide Rumination is a significant predictor of Cognitive depression, explaining approximately 8.05% of its variance, thereby fully supporting Hypothesis 2a. However, the effect of Suicide Rumination on Ethical Suicide Acceptance did not emerge as significant, failing to support Hypothesis 2b, while its impact on Suicide Legitimization was also non-significant, not supporting Hypothesis 2c. Cognitive depression was found to have a substantial effect in the models for both Ethical Suicide Acceptance and Suicide Legitimization, supporting Hypotheses 3a and 3b. In the comprehensive model assessing Acutely-ill Patients' Suicide Acceptance, incorporating all mediators, a significant variance (R-squared = 0.6625) was explained. Notably, Suicide Rumination, Ethical Suicide Acceptance, and Suicide Legitimization all emerged as significant predictors of this acceptance, with varying effects, thus supporting Hypotheses 4a and 4b. The role of Cognitive depression in this model was marginally significant, offering limited support for Hypothesis 4c. Crucially, the indirect effects of Suicide Rumination on Acutely-ill Patients' Suicide Acceptance through different mediational paths varied in significance and impact. The indirect effect via Cognitive depression alone, and through the sequential combination of Cognitive depression and Ethical Suicide Acceptance, were significant, highlighting the nuanced role of these mediators. These findings underscore the importance of considering multiple pathways in understanding the dynamics of Suicide Rumination and its influence on the acceptance of suicide among acutely-ill patients.
This paper presents a comprehensive analysis of the legal, cultural, ethical, and psychological dimensions of euthanasia, doctor-assisted killing, and suicide in China. The findings highlight the significant direct and mediated effects of suicide rumination on the acceptance of suicide among acutely-ill patients. The study contributes valuable insights into the evolving bioethics and the interplay of various factors in the context of end-of-life decision-making in modern Chinese society.
Understanding the will to die in patients with a serious
and incurable disease is essential due to its complexity and potential
connection with requests for hastened death. This systematic review ...aimed to
identify any new assessment tools developed since 2016 to evaluate the will to
die and determine if there is a relationship with the growing legalization of
hastened death processes. The review followed the PRISMA guidelines, and out of
1,588 initially identified studies, 33 were selected for analysis. Within this
review, 12 assessment tools were identified, of which 7 were new instruments
used since 2016. However, the overall reliability and validity of these new
tools ranged from inadequate to good when analyzing the psychometric
information. The identified assessment tools appear to have conceptual
limitations when applied in the context of hastened death evaluation. Based on
the findings of this systematic review, there is a need for new instruments
specifically designed for assessing the will to die within the context of
hastened death. These new tools should have robust content validity, focusing on
the motivators behind the will to hasten death to address this process's
increasing legalization.
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Background
Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To ...date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD.
Methods
This study is part of the East Asian Collaborative Cross‐Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250‐mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD.
Results
In total, 1530 patients were included in the analysis. Country, religion, spiritual well‐being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P = .032) than those without AH.
Conclusions
AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD.
Lay Summary
Our prospective cross‐cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer.
The findings reveal that country, religion, spiritual well‐being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD).
After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P = .032) than those without AH.
Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end‐of‐life stage and achieve a good death.
Artificial hydration (AH) use affects the quality of death (QOD) of terminally ill patients with cancer cared for in palliative care units. Patients administered 250 to 499 mL of AH have significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P = .032) than those without AH.
The term double awareness has been used in the context of advanced cancer to describe a person's capacity to be engaged in the world while preparing for impending death. This phenomenon holds great ...import for psychotherapeutic interventions geared toward those coping with a fatal illness, but research on this phenomenon has only emerged recently. The aims of this article are (a) to describe the phenomenon of double awareness and (b) to present a developing, rational model of how double awareness might be cultivated in the process of a recently developed, integrative psychotherapy called "Managing Cancer And Living Meaningfully." Task analysis method was used to guide construction of this rational model. The article integrates relevant knowledge from existential, experiential, humanistic, and psychodynamic psychotherapy related to the problem of advanced disease and impending mortality and offers a framework for future research on this important topic.
"Doble conocimiento" en psicoterapia para pacientes que viven con cáncer avanzado
El término doble conocimiento se ha utilizado en el contexto del cáncer avanzado para describir la capacidad de una persona para participar en el mundo mientras se prepara para la muerte inminente. Este fenómeno tiene gran importancia para las intervenciones psicoterapéuticas dirigidas a aquellos que enfrentan una enfermedad mortal, pero la investigación sobre este fenómeno solo ha surgido recientemente. Los objetivos de este artículo son (a) describir el fenómeno del conocimiento doble y (b) presentar un modelo racional en desarrollo de cómo se puede cultivar el conocimiento doble en el proceso de una psicoterapia integradora recientemente desarrollada llamada 'Administración del cáncer y la vida' Significativamente. El método de análisis de tareas se utilizó para guiar la construcción de este modelo racional. El artículo integra el conocimiento relevante de la psicoterapia existencial, experiencial, humanística y psicodinámica relacionada con el problema de la enfermedad avanzada y la mortalidad inminente, y ofrece un marco para futuras investigaciones sobre este importante tema.
晚期癌症患者在心理治疗中的"双重意识"
术语"双重意识"已被用于晚期癌症中，以描述一个人在准备即将到来的死亡的同时参与世界的能力。 这种现象对于针对致命疾病的心理治疗干预措施具有重大意义，但近来对这一现象的研究才刚刚出现。 本文的目的是（a）描述双重意识（这种）现象，（b）提出一个发展中的合理模式，即在最近开发的一个称之为"管理癌症与有意义地生活"的综合心理治疗过程中如何培养双重意识。 任务分析法用于指导该理性模型的构建。 本文将存在，体验，人文，精神心理治疗相关知识与先进疾病和即将到来的死亡问题相结合，为未来对这一重要课题的研究提供了框架。
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Working with terminally ill patients is regarded as a stressful or traumatic event and may lead to negative outcomes, including job burnout and secondary traumatic stress (STS). Psychological ...resilience might protect employees from the negative consequences of stress. The aim of this study was to determine the mediating role of job burnout in the relationship between psychological resilience and STS. The study included 72 nurses aged from 22 to 72 years old (M = 46.01, SD = 10.69), working with terminally ill patients. The recipients completed 3 questionnaires: the Secondary Traumatic Stress Scale, the Oldenburg Burnout Inventory, and the Resilience Measurement. The results reveal negative associations between resilience, job burnout, and secondary traumatic stress, and a positive correlation between secondary traumatic stress and job burnout. Mediation analysis showed that job burnout plays a mediating role in the relationship between psychological resilience and secondary traumatic stress. Our findings highlight the role played by job burnout in the manifestation of STS. Professional and nonprofessional interventions for individuals experiencing work-related traumatic stress would benefit from interventions that build personal resources.
Impact Statement
The aim of the research was to draw individuals attention to psychologically risk associated with helping terminally ill people. This study show that nurses experiencing job burnout may be more susceptible to secondary traumatic stress after indirect exposure to trauma. The findings also suggest that building personal resources in the form of resilience is an important thing that supports mental health and enables to perform the professional role adequately.
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Objective To investigate the effect of palliative care in pain management of terminally ill patients. Methods A total of 50 terminally ill patients with pain were divided into the control group and ...observation group according to the admission sequence, with 25 cases in each group. Patients in the control group received routine nursing and pain management, and those in the observation group were given palliative care interventions in addition. The degree of pain was evaluated using a Visual Analogue Scale(VAS). Results The VAS score was decreased in both two groups after intervention, and VAS score in the observation group was lower than that in the control group (P＜0. 01). Conclusion Palliative care is effective to reduce the pain of terminally ill patients, and it helps to improve the quality of life in terminal stage. (目的 探讨安宁疗护在临终患者疼痛管理中的应用。方法 选取医院老年科2021年1月—2022年12月收治的50例临终患者为研究对象, 均伴有不同程度的疼痛。根据入院时间将患者分为观察组和对照组, 各25例。对照组采用常规护理和疼痛管理, 观察组在对照组基础上增加安宁疗护, 对比两组患者疼痛视觉模拟量表(VAS)评分。结果 干预后两组VAS量表评分降低, 且观察组VAS量表评分低于对照组, 差异有统计学意义(P＜0. 01)。结论 安宁疗护能有效缓解临终患者疼痛, 有助于改善生存质量。)
Abstract Introduction Terminal illness is an irreversible illness that, without life-sustaining procedures, usually results in death or permanent disability from which recovery is unlikely. When ...involved, family caregivers are believed to improve health outcomes, such as reduced hospitalization, and establishing a patient’s initial access to professional treatment services. However, caring for a patient with a terminal illness is viewed as one of the most difficult aspects of providing care. This study aimed to identify the challenges, and coping strategies developed by family caregivers to cope with the care of the terminally ill person. Methods An exploratory descriptive qualitative approach was used. Twenty (20) family caregivers voluntarily participated in the study from the Korle-Bu Teaching Hospital. Semi-structured interviews were conducted with the participants. The transcribed interviews were then analysed using thematic analysis. Results From the analysis, three main themes emerged: challenges, coping strategies, and social support. These themes encompassed sixteen subthemes including financial burden, bad health conditions, faith and prayer, and support from health professionals. From the study, both male and female family caregivers narrated that providing care for sick relatives undergoing terminal disease is characterized as a daily duty demanding one’s time and fraught with emotional strain. In addition, even though it was a difficult job, family members who provided care for ailing relatives never gave up, citing responsibility, the importance of family, and religious beliefs as the primary motivations for doing so. Conclusion The difficulties and demands of family caregiving roles for terminally ill relatives are complex and multifactorial. The findings call for multidisciplinary professional attention for family caregivers and policies that will support their lives holistically.
Presents a poem that is written from the perspective of a dying patient who is thanking the medical team that attempts to resuscitate them. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Patients in palliative care are the population cohort that most frequently develop pressure injuries, severely impacting their quality of life. Data from prospective studies on the prevalence and ...incidence of pressure injuries in hospices are lacking.
To describe the point prevalence and cumulative incidence of pressure injuries in patients admitted to residential hospices, and to analyze their predictive factors over time.
Multicentre prospective longitudinal observational study.
Adult patients (n = 992) enrolled in 13 Italian residential hospices, with a minimum sample of 280 for each macro-region (North, center, South/Islands).
Assessments including the Karnofsky Performance Status, Braden, Edmonton Symptom Assessment System Revised scales and pressure injury staging according to National Pressure Ulcer Advisory Panel were conducted at least every four days, from admission to patients’ death/discharge.
The 7,967 observations recorded provided prevalence and incidence rates of 34.1% and 26.5%, respectively. The logistic regression model showed non-cancer disease (OR = 2.39, 95%CI = 1.65–3.47), age >80 (OR = 2.01, 95%CI = 1.49–2.71), Braden score ‘at risk’ (OR = 1.92, 95%CI = 1.17–3.14), urinary catheter (OR = 1.96, 95%CI = 1.40–2.75), drowsiness (OR = 1.41, 95%CI = 1.02–1.95) and artificial nutrition (OR = 1.47, 95%CI = 1.01–2.14) as the variables associated with pressure injury at admission. The generalized estimating equations models, built on the timeframes for observation groups, revealed male gender (OR = 1.68, 95%CI = 1.01–2.79) and Braden score ‘at risk’ (OR = 4.45, 95%CI = 1.74–11.34) as predictive factors of a new pressure injury developed up to three weeks before a patient's death, while in the last ten days of life these predictors were replaced by diagnosis of cancer (OR = 1.80, 95%CI = 1.11–2.91), worsening pain (OR = 1.65, 95%CI = 1.10–2.49), drowsiness (OR = 1.79, 95%CI = 1.25–2.57) and dyspnea (OR = 1.48, 95%CI = 1.01–2.18).
The high incidence and prevalence of pressure injuries confirm the importance of palliative care nurses continuously focusing on prevention and management strategies. In the last three weeks of a patient's life, the predictive power of the Braden scale for a new pressure injury is not confirmed, throwing doubt on the effectiveness of aimed interventions at modifying risk factors.
Along the different disease trajectories, pressure injuries developed during the instability/worsening phases of illness, occurring before hospice admission for non-cancer patients and in the end-of-life phase for cancer patients. Despite continuous provision of appropriate interventions, most of the new pressure injuries were detected during the last ten days of a patient's’ life and assessed as 'unavoidable'. These results are crucial to guiding palliative care nursing plans during the different phases of illness, and to predicting care needs, possible management strategies (‘wound management’ vs. ‘wound palliation’), and resource utilization.
