Existential issues were significantly correlated with the will to live in a study of 189 end-stage cancer patients.
Harvey Max Chochinov, M.D., professor of psychiatry at the University of Manitoba (Canada), and his colleagues examined the simultaneous influences of existential, psychiatric, and physical issues on the will to live in terminally ill patients (Psychosomatics 2005;46:7–10).
In a multiple regression analysis, each of the existential issues assessed–hopelessness, sense of dignity, and being a burden to others–was significantly correlated with the will to live.
In addition, psychiatric issues such as depression, anxiety, and concentration were significantly associated with the will to live. Social variables–including support from family friends and health care providers, and patient satisfaction with this support–also were significantly correlated with the will to live.
Physical issues, particularly dyspnea, appetite, and appearance, were significantly correlated as well, but to a lesser degree than were existential, psychiatric, and social issues.
The patients, who were recruited from two Canadian palliative care facilities, shared information about their end-of-life experiences, which were rated on a symptom distress scale developed for cancer patients and an index of independence in activities of daily living. The mean age of patients was 69 years, and almost half were men. The most common cancers were lung (29%), gastrointestinal tract (26%), genitourinary system (16%), and breast (15%).
In a univariate analysis, hopelessness was highly predictive of suicidal ideation, as was a feeling of being a burden to others and a wish to die with dignity. The inclusion of dignity in the model suggests that patients who lose their sense of self and feel that their lives are no longer valued have less will to live. “It would appear that losing one's sense of meaning and purpose–experiencing life as having become redundant or futile–is an important existential underpinning of the loss of will to live among the dying,” Dr. Chochinov and his associates noted.
Although the study was limited by its focus on cancer patients, the results highlight the need to examine the factors driving terminal patients' wills to live in order to provide appropriate palliative care. The study was supported in part by the National Cancer Institute of Canada.