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An international consensus definition of the wish to hasten death and its related factors

Publicated to:PLoS ONE. 11 (1): e0146184- - 2016-01-04 11(1), DOI: 10.1371/journal.pone.0146184

Authors: Balaguer, Albert; Monforte-Royo, Cristina; Porta-Sales, Josep; Alonso-Babarro, Alberto; Altisent, Rogelio; Aradilla-Herrero, Amor; Bellido-Perez, Mercedes; Breitbart, William; Centeno, Carlos; Angel Cuervo, Miguel; Deliens, Luc; Frerich, Gerrit; Gastmans, Chris; Lichtenfeld, Stephanie; Limonero, Joaqun T; Maier, Markus A; Johan Materstvedt, Lars; Nabal, Maria; Rodin, Gary; Rosenfeld, Barry; Schroepfer, Tracy; Tomas-Sabado, Joaquin; Trelis, Jordi; Villavicencio-Chavez, Christian

Affiliations

ATLANTES Research Program, Institute for Culture and Society and Palliative Medicine Department, University of Navarra, Navarra, Spain - Author
Autonomous Univ Barcelona, Escola Univ Infermeria Gimbernat, Barcelona, Spain - Author
Bellvitge Biomed Res Inst IDIBELL, Inst Catala Oncol, Palliat Care Serv, Barcelona, Spain - Author
Catholic University of Leuven, Leuven, Belgium - Author
Complejo Hosp Infanta Cristina, Badajoz, Spain - Author
Complejo Hospitalario Infanta Cristina, Badajoz, Spain - Author
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany - Author
Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway - Author
Department of Psychology, Fordham University, Bronx, NY, United States - Author
Department of Supportive Care, Palliative and End-Life Care (GIPPEC), University of Toronto, Ontario, Canada - Author
End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium - Author
Escola Universitària D'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain - Author
Faculty of Psychology, Stress and Research Group, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain - Author
Fordham Univ, Dept Psychol, Bronx, NY 10458 USA - Author
Hosp Arnau Vilanova, Inst Catala Salut, IRB, Palliat Care Support Team, Lleida, Spain - Author
Hosp Univ La Paz, Unidad Cuidados Paliat, Madrid, Spain - Author
Institute of Health Research Aragon, Cátedra de Profesionalismo y Ética Clínica, Universidad de Zaragoza, Zaragoza, Spain - Author
Katholieke Univ Leuven, Leuven, Belgium - Author
Ludwig-Maximilians-Universität Mönchen, Munich, Germany - Author
Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA - Author
Memorial Sloan-Kettering Cancer Center, New York, NY, United States - Author
Norwegian Univ Sci & Technol NTNU, Fac Humanities, Dept Philosophy & Religious Studies, Trondheim, Norway - Author
Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain - Author
Palliative Care Service, Institut Català D'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain - Author
Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova Lleida, Institut Català de la Salut, Lleida, Spain - Author
School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain - Author
School of Social Work, University of Wisconsin-Madison, Wisconsin, United States - Author
Unidad de Cuidados Paliativos, Hospital Universitario la Paz, Madrid, Spain - Author
Univ Autonoma Barcelona, Fac Psychol, Stress & Res Grp, E-08193 Barcelona, Spain - Author
Univ Ghent, End Of Life Care Res Grp, Brussels, Belgium - Author
Univ Hosp Cologne, Dept Palliat Med, Cologne, Germany - Author
Univ Int Catalunya, Sch Med & Hlth Sci, Barcelona, Spain - Author
Univ Int Catalunya, Sch Med & Hlth Sci, Dept Nursing, Barcelona, Spain - Author
Univ Munich, Munich, Germany - Author
Univ Navarra, Univ Navarra Clin, Inst Culture & Soc, ATLANTES Res Program, Navarra, Spain - Author
Univ Navarra, Univ Navarra Clin, Palliat Med Dept, Navarra, Spain - Author
Univ Toronto, Dept Psychiat, Princess Margaret Canc Ctr, Dept Support Care, Toronto, ON M5S 1A1, Canada - Author
Univ Toronto, GIPPEC, Toronto, ON M5S 1A1, Canada - Author
Univ Wisconsin, Sch Social Work, Madison, WI 53706 USA - Author
Univ Zaragoza, Inst Hlth Res Aragon, Catedra Profesionalismo & Et Clin, Zaragoza, Spain - Author
Vrije Univ Brussel, Brussels, Belgium - Author
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Abstract

The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

Keywords
CanadaConsensusConsensus developmentDeathDoctor patient relationEuropeGroup processHumanHuman experimentScientist

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal PLoS ONE due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2016, it was in position 15/63, thus managing to position itself as a Q1 (Primer Cuartil), in the category Multidisciplinary Sciences.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.96. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 5.05 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 28.38 (source consulted: Dimensions Apr 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-04-29, the following number of citations:

  • WoS: 74
  • Scopus: 93
  • Europe PMC: 31
  • OpenCitations: 113
Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-04-29:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 202.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 200 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 16.68.
  • The number of mentions on the social network Facebook: 3 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 15 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.
Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Belgium; Canada; Germany; Norway; United States of America.