Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer

J Pain Symptom Manage. 2017 Dec;54(6):826-834. doi: 10.1016/j.jpainsymman.2017.04.018. Epub 2017 Aug 16.


Context: Meaning in life (MiL) is a key factor for ensuring spiritual well-being and quality of life among patients with life-threatening illnesses. However, the role of MiL in relation to the wish to hasten death (WTHD) and its interaction with other physical and psychological factors in patients with advanced cancer has not yet been studied.

Objective: The objective of this study was to analyze the relationship between the WTHD and MiL and to propose a theoretical model of functional relationships among WTHD, performance status, depression, and MiL.

Methods: This is a cross-sectional study of 101 patients in a palliative care unit, who were assessed in the context of a clinical interview. Outcome measures included performance status, depression, MiL, and the WTHD. Structural equation modeling was used to analyze the functional relationships between these factors.

Results: The WTHD correlated significantly (P < 0.01) with MiL (r = 0.60), performance status (r = 0.548), and depression (r = 0.397). The structural equation modeling analysis showed that although there was no significant direct effect between performance status and the WTHD, there was a significant total effect because of the mediation of depression and MiL. The latter played the most significant role, accounting for 76.5% of the mediation.

Conclusion: These results support the proposed model and provide evidence of a mediator effect of MiL and depression on the relationship between physical impairment and the WTHD in advanced patients. Our findings suggest that interventions to enhance MiL could help to address and/or prevent the emergence of a WTHD in this population.

Keywords: Wish to hasten death; advanced illness; desire to die; meaning in life; mediation model; palliative care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Attitude to Death*
  • Cross-Sectional Studies
  • Depression
  • Disability Evaluation
  • Female
  • Humans
  • Karnofsky Performance Status
  • Male
  • Middle Aged
  • Models, Statistical
  • Neoplasms / physiopathology*
  • Neoplasms / psychology*
  • Palliative Care
  • Quality of Life / psychology
  • Terminally Ill / psychology*