The desire for hastened death among cancer patients near the end of life: Are hopelessness, depression, and quality of life mediated by the valuation of life construct

This study provides a test of a mediation hypothesis proposed by M.P. Lawton and colleagues (2001) which asserted that an existential construct, titled the Valuation of Life (VOL), mediates the relationship between quality of life variables and the desire for hastened death. The VOL construct is theorized to be a cognitive-affective schema through which the positive and negative aspects of life are evaluated by those who are facing serious illness to provide an overall evaluation of the total worth of life. VOL is comprised of five domains: purpose and meaning, persistence, futurity, hope, and self-efficacy. Forty-nine cancer patients receiving palliative care services completed a self-report questionnaire that assessed their levels of quality of life (FACTG), depression (BDI-SF), hopelessness (BHS), desire for hastened death, and valuation of life. Functional status (KPS) was also assessed. Results of a mediation analysis that followed the causal modeling approach outlined by Baron & Kenny (1986) and which used a bootstrap method to test the significance of the mediation effects indicated that VOL mediated the relationship between desire for death and all four predictor variables (FACTG, BDI-SF, BHS, KPS). This research highlights the pivotal role that existential constructs play in the desire for early death among those with advanced cancer. This research also stresses the need for clear definitions of existential and spiritual constructs and accentuates the value of theory-driven research in palliative care.