Wishful thinking: an examination of palliative home care clients who expressed a wish to die now

PURPOSE: To provide the highest quality of person centered palliative care clinicians should prioritize understanding of client needs and preferences at end of life to inform tailored care planning. During clinical assessments, clients may voluntarily express a ‘wish to die’ either directly to the clinician or it may be indirectly reported second-hand to the clinician through an informal caregiver or family member. METHODS: This study examined 4,840 interRAI Palliative Care assessments from community dwelling palliative home care clients in Ontario, Canada (2006–2011). The interRAI PC gathers a wide range of information on physical, cognitive, and social domains, as well as demographic, health service utilization, and care preferences which is then used by the clinician to inform the care planning process RESULTS: 308 palliative home care clients (6.7 %) voluntarily expressed a ‘wish to die now’. In multivariate analyses predicting expression of a ‘wish to die’ strong independent variables included not being married/widowed, a shorter estimated prognosis, depressive symptoms, functional impairment, excessive amount of sleep, feeling completion regarding financial/legal matters, and struggling with the meaning of life. Of clients who expressed a ‘wish to die now’, clients who exhibited depressive symptoms (23.8 %) were also more likely to exhibit cognitive impairment and recent cognitive decline, weight loss, psychological distress. DISCUSSION: Not all clients who expressed a ‘wish to die’ exhibited depression, pain and psychological distress. Findings promote the need for an individualized approach to care management. Clinicians should strive to embrace not fear discussing with the client their preferences for death.