WISHFUL THINKING: AN EXAMINATION OF PALLIATIVE HOME CARE CLIENTS WHO EXPRESSED A WISH TO DIE NOW
Bibliographic record
Abstract
PURPOSE: To provide the highest quality of person centered palliative care clinicians should prioritize understanding of client needs and preferences at end of life to inform tailored care planning. During clinical assessments, clients may voluntarily express a ‘wish to die’ either directly to the clinician or it may be indirectly reported second-hand to the clinician through an informal caregiver or family member. METHODS: This study examined 4,840 interRAI Palliative Care assessments from community dwelling palliative home care clients in Ontario, Canada (2006–2011). The interRAI PC gathers a wide range of information on physical, cognitive, and social domains, as well as demographic, health service utilization, and care preferences which is then used by the clinician to inform the care planning process RESULTS: 308 palliative home care clients (6.7 %) voluntarily expressed a ‘wish to die now’. In multivariate analyses predicting expression of a ‘wish to die’ strong independent variables included not being married/widowed, a shorter estimated prognosis, depressive symptoms, functional impairment, excessive amount of sleep, feeling completion regarding financial/legal matters, and struggling with the meaning of life. Of clients who expressed a ‘wish to die now’, clients who exhibited depressive symptoms (23.8 %) were also more likely to exhibit cognitive impairment and recent cognitive decline, weight loss, psychological distress. DISCUSSION: Not all clients who expressed a ‘wish to die’ exhibited depression, pain and psychological distress. Findings promote the need for an individualized approach to care management. Clinicians should strive to embrace not fear discussing with the client their preferences for death.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".