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Validation of the German version of the Schedule of Attitudes Toward Hastened Death (SAHD–D) with patients in palliative care

Published online by Cambridge University Press:  22 May 2014

Maren Galushko ,
Julia Strupp Open the ORCID record for Julia Strupp [Opens in a new window] ,
Johanna Walisko-Waniek ,
Moritz Hahn ,
Sabine Löffert ,
Nicole Ernstmann ,
Holger Pfaff ,
Lukas Radbruch ,
Friedemann Nauck  and
Christoph Ostgathe
...Show all authors
Maren Galushko
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
Julia Strupp*
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
Johanna Walisko-Waniek
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
Moritz Hahn
Affiliation:
Institute for Medical Statistics and Epidemiology, University Hospital of Cologne, Cologne, Germany
Sabine Löffert
Affiliation:
German Hospital Institute, Düsseldorf, Düsseldorf, Germany Center for Health Services Research, University of Cologne, Cologne, Germany
Nicole Ernstmann
Affiliation:
Center for Health Services Research, University of Cologne, Cologne, Germany
Holger Pfaff
Affiliation:
Center for Health Services Research, University of Cologne, Cologne, Germany
Lukas Radbruch
Affiliation:
Department of Palliative Medicine, University Hospital of Bonn, Bonn, Germany Center for Integrated Oncology–Cologne/Bonn, Cologne, Germany
Friedemann Nauck
Affiliation:
Department of Palliative Medicine, University Hospital of Göttingen, Göttingen, Germany
Christoph Ostgathe
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany Department of Palliative Medicine, Comprehensive Cancer Center, Erlangen, EMN, University Hospital, Erlangen, Germany
Raymond Voltz
Affiliation:
Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany Center for Integrated Oncology–Cologne/Bonn, Cologne, Germany Clinical Trials Center, Cologne, Germany
*
Address correspondence and reprint requests to: Julia Strupp, Department of Palliative Care, University Hospital, Cologne, Kerpener Strasse. 62, 50937 Cologne, Germany. E-mail: [email protected]
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Abstract

Objective:

Reliable and validated instruments are needed in order to study the desire for hastened death (DHD). As there is no instrument in the German language to measure DHD, our aim was to validate a German version of the Schedule of Attitudes Toward Hastened Death (SAHD–D).

Method:

The SAHD was translated following guidelines promulgated by the European Organization for Research and Treatment of Cancer (EORTC). In eligible patients (clinical situation adequate, MMSE ≥21), the following instruments were employed: a symptom checklist (HOPE), the HADS–D (Hospital Anxiety and Depression Scale), the EORTC-QLQ-PAL15, and the SAHD–D, as well as an external estimation of DHD provided by the attending physician. A high level of DHD was defined as the mean plus one standard deviation (SD).

Results:

Of the 869 patients assessed, 92 were eligible for inclusion (66% females, mean age of 64.5 years). The SAHD–D total score ranged from 0 to 18, with a mean of 5 and a standard deviation (SD) of 3.7. A high level of DHD was found in 20% (n = 19). For discriminant validity, significant correlations were found between the SAHD–D and depression (rrho = 0.472), anxiety (rrho = 0.224), and clinical state (rrho = 0.178). For criterion validity, the external estimate of DHD showed a low significant correlation with patient score (rrho = 0.290). Factor analysis of the SAHD–D identified two factors.

Significance of results:

Validation of the SAHD–D illustrated good discriminant validity, confirming that a desire to hasten death is a construct separate from depression, anxiety, or physical state. The unidimensionality of the SAHD could not be reproduced. Our findings support the multifactorial interdependencies on DHD and suggest that the SAHD–D should be refined by considering actual wishes, general attitudes, and options of patients.

Keywords

Palliative careValidationDesire for hastened deathSAHD
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 3 , June 2015 , pp. 713 - 723
Copyright
Copyright © Cambridge University Press 2014 

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Footnotes

*

Both authors contributed equally to this work.

References

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