From will to live to will to die: oncologists, nurses, and social workers identification of suicidality in cancer patients
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The purpose of this research was to examine how oncologists, nurses, and social workers identify suicidality in cancer patients.
Sixty-one healthcare professionals (23 oncologists, 18 social workers, and 20 nurses) at two academic cancer centers were interviewed using an in-depth interview guide. This was a qualitative study based on grounded theory methodology. Analysis involved line-by-line coding, with categories and themes emerging from participants’ narratives.
Suicidality in cancer patients exists on a wide spectrum that ranges from an active will to live to an active will to die. Four phases were identified that included: (A) a strong will to live expressed in themes of active treatments, seeking second opinions, overtreatment, and alternative treatments; (B) a decreasing will to live indicated in themes of mental health distress and physical pain and suffering; (C) a readiness to die expressed in themes of mental health distress, previous mental health diagnoses, physical pain, avoiding more suffering, preserving quality of life in old age, nearing end of life, lack of social support, and maintaining a sense of control; and (D) a will to die indicated in themes of euthanasia and active suicidality.
Suicidality in cancer patients exists on a continuum. Cancer patients fluctuate on this spectrum depending on circumstances such as degree of suffering, their personalities and life circumstances, and whether they are nearing the end of life. Results of the study emphasize the need to collect more context specific data on suicidality among cancer patients and the importance of early integration of psychosocial and palliative care in the cancer treatment trajectory.
KeywordsAssessment Suicidality Cancer Oncology
Compliance with ethical standards
Approvals were obtained from the Research Ethics Board prior to launching the study. Informed consent was obtained from all individual participants included in the study that agreed to the interview being audio-recorded. A semi-structured interview guide was used and interviews were recorded and transcribed, with all identifiable information removed from the transcripts.
Conflict of interest
The authors declare that they have no conflict of interest.
This work was supported by the American Foundation for Suicide Prevention [Pilot Research Grant to Granek].
- 4.Nakash O, Barchana M, Liphshitz I, Keinan-Boker L, Levav I (2012) The effect of cancer on suicide in ethnic groups with a differential suicide risk. Eur J Public Health cks045Google Scholar
- 6.Nakash O, Levav I, Aguilar-Gaxiola S, Alonso J, Andrade LH, Angermeyer MC, Bruffaerts R, Caldas-de-Almeida JM, Florescu S, Girolamo G (2014) Comorbidity of common mental disorders with cancer and their treatment gap: findings from the World Mental Health Surveys. Psycho-Oncology 23:40–51CrossRefPubMedGoogle Scholar
- 23.Glaser B, Strauss A (1967) The discovery of grounded theory: strategies for qualitative inquiry. Aldin, ChicagoGoogle Scholar
- 27.Filiberti A, Ripamonti C (2001) Suicide and suicidal thoughts in cancer patients. Tumori 88:193–199Google Scholar
- 31.Mirshahidi H, Nasseri K, Mills P (2011) Suicide in patients with cancer in California: 2000-2005. ASCO Ann Meet Proc 29(suppl):abstract 1535Google Scholar
- 40.Stagl JM, Bouchard LC, Lechner SC, Blomberg BB, Gudenkauf LM, Jutagir DR, Glück S, Derhagopian RP, Carver CS, Antoni MH (2015) Long-term psychological benefits of cognitive-behavioral stress management for women with breast cancer: 11-year follow-up of a randomized controlled trial. Cancer 121:1873–1881CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, Firn JI, Paice JA, Peppercorn JM, Phillips T (2016) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol (published online before print October 28, 2016)Google Scholar
- 44.Bentur N, Emanuel LL, Cherney N (2012) Progress in palliative care in Israel: comparative mapping and next steps. Isr J Health Policy Res 1Google Scholar
- 45.Gans D, Kominski GF, Roby DH, Diamant AL, Chen X, Lin W, Hohe N (2012) Better outcomes, lower costs: palliative care program reduces stress, costs of care for children with life-threatening conditions. UCLA Center for Health Policy Research, UCLA, CAGoogle Scholar