Skip to main content
    • Aa
    • Aa

The schedule of attitudes toward hastened death: Validation analysis in terminally ill cancer patients


Objective: The faithful translation of the English version of the Schedule of Attitudes toward Hastened Death (SAHD) into Greek and its validation as an assessment tool in terminally ill cancer patients receiving palliative treatment.

Methods: 120 terminally ill cancer patients attending a Palliative Care Unit, at the University of Athens, Greece, between June 2003 and November 2003 for palliative treatment.

Results: SAHD would be a useful instrument for measuring desire for hastened death with valid psychometric properties in a Greek cancer population. The SAHD demonstrated high reliability. Desire for hastened death was significantly associated with Hospital Anxiety and Depression Scale (HAD) depression (r = 0.607, p < 0.0005) and substantially correlated with HAD anxiety (r = 0.502, p < 0.0005). “Pain intensity” had a moderate correlation with SAHD scores (r = 0.28, p = 0.01) and SAHD scores correlated significantly with “pain interference in mood” (r = 0.38, p = 0.01) and in “enjoyment of life” (r = 0.34, p = 0.03). SAHD correlation with quality of life was statistically significant (r = −0.38, p < 0.01) as was health status (r = −0.36, p < 0.01). Patients with a Poor Performance Status (from Eastern Cooperative Oncology Group scale) correlated significantly with high scores in SAHD (p = 0.038). Factor analysis supported the unidimentionality of the measurement.

Significance of results: SAHD could be a useful and valid instrument for measuring desire for hastened death in Greek terminally ill cancer patients.

Corresponding author
Correspondence author: Kyriaki Mystakidou, Pain Relief and Palliative Care Unit, Department of Radiology, Areteion Hospital, School of Medicine, University of Athens, 27 Korinthias Str., 115 26 Athens, Greece. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ-C30; A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365376.

Allebeck, P., Bolund, C., & Ringback, G. (1989). Increased suicide rate in cancer patients. A cohort study based on the Swedish Cancer-Environment Register. Journal of Clinical Epidemiology, 42, 611616.

Back, A.L., Wallace, J.I., Starks, H.E., et al. (1996). Physician-assisted suicide and euthanasia in Washington State. Journal of the American Medical Association, 275, 919925.

Bolund, C. (1985). Suicide and cancer: II. Medical and care factors in suicide by cancer patients in Sweden, 1973–1976. Journal of Psychosocial Oncology, 3, 1730.

Breitbart, W., Bruera, E., Chochinov, H., et al. (1995). Neuropsychiatric syndromes and psychiatric symptoms in patients with advanced cancer. Journal of Pain and Symptom Management, 10, 131141.

Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. Journal of the American Medical Association, 284, 29072911.

Crocetti, E., Arniani, S., Accia, S., et al. (1998). High suicide mortality soon after diagnosis among cancer patients in central Italy. British Journal of Cancer, 77, 11941196.

Cronbach, L.J. (1951). Coefficient alpha and the internal structure of test. Psychometrica, 16, 297334.

Derogatis, L.R., Marrow, G.R., Fetting, J., et al. (1983). The prevalence of psychiatric disorders among cancer patients. Journal of the American Journal Association, 249, 751757.

Emanuel, J.E. (2002). Euthanasia and physician-assisted suicide: A review of the empirical data from the United States. Archives of Internal Medicine, 162, 142152.

Emanuel, J.E., Fairclough, L.D., Daniels, E.R., et al. (1996). Euthanasia and physician-assisted suicide: Attitudes and experiences of oncology patients. Oncologists, and the public. Lancet, 347, 18051810.

Filiberti, A., Audisio, R.A., & Kaasa, S. (1998). Psychosocial issues in old cancer patients. Critical Reviews in Oncology and Hematology, 27, 132133.

Foley, K. (1995). Pain, physician assisted suicide, and euthanasia. Pain Forum, 4, 163178.

Fox, B.H., Stanek, E.J., Boyd, S.C., et al. (1982). Suicide rates among cancer patients in Connecticut. Journal of Chronic Disease, 35, 85100.

Ganzini, L. & Block, S. (2002). Physician assisted death: A last resort?New England Journal of Medicine, 346, 16631665.

Ganzini, L., Johnston, W.S., McFarland, B.H., et al. (1998). Attitudes of patients with Amyotrophic Lateral Sclerosis and their care givers toward assisted suicide. New England Journal of Medicine, 339, 967973.

Henderson, J.M. & Ord, R.A. (1997). Suicide and neck cancer patients. Journal of Oral Maxillofacial Surgery, 55, 12171221.

Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale. A review of validation data and clinical results. Journal of Psychosomatic Research, 42, 1741.

Kahn, J.M., Lazarus, J.C., & Owens, P.D. (2003). Allowing patients to die: Practical, ethical and religious concerns. Journal of Clinical Oncology, 21, 30003002.

Levi, F., Bulliard, J., & La Vecchia, C. (1991). Suicide risk among incident cases of cancer in the Swiss Canton of Vaud. Oncology, 48, 4447.

Lloyd-Williams, M. (2002). How common are thoughts of self-harm in a UK palliative care population?Supportive Care in Cancer, 10, 422424.

Louhivouori, K.A. & Hakama, J. (1979). Risk of suicide among cancer patients. American Journal of Epidemiology, 109, 5965.

Meier, D.E., Emmons, C., Wallenstein, S., et al. (1998). A national survey of physician-assisted suicide and euthanasia in the United States. New England Journal of Medicine, 338, 11931201.

Moorey, S., Greer, S., Watson, M., et al. (1991). The factor structure and factor stability of the Hospital Anxiety and Depression Scale in patients with cancer. British Journal of Psychiatry, 158, 255259.

Mystakidou, K., Mendoza, T., Tsilika, E., et al. (2001a). Greek Brief Pain Inventory: Validation and utility in cancer pain. Oncology, 60, 3542.

Mystakidou, K., Tsilika, E., Parpa, E., et al. (2001b). The EORTC Core Quality of Life Questionnaire (QLQ-C30-c30, Version 3.0) in terminally ill cancer patients under palliative care: Validity and reliability in a Hellenic sample. International Journal of Cancer, 94, 135139.

Mystakidou, K., Tsilika, E., Kouloulias, V., et al. (2004). The “Palliative Care Quality of Life Instrument (PQLI)” in terminal cancer patients. Health & Quality of Life Outcomes, 2, 8.

Owen, C., Tennant, C., Levi, J., et al. (1992). Suicide and euthanasia: Patient attitudes in the context of cancer. Psychooncology, 1, 7988.

Pessin, H., Rosenfeld, B., & Breitbart, W. (2002). Assessing psychological distress near the end of life. American Behavioral Science, 46, 357372.

Rosenfeld, B. (2000). Assisted suicide, depression and the right to die. Psychology, Public Policy and Law, 6, 467488.

Rosenfeld, B., Breitbart, W., Galietta, M., et al. (2000). The schedule of attitudes toward hastened death. Cancer, 88, 28682875.

Rosenfeld, B., Breitbart, W., Stein, K., et al. (1999). Measuring desire for death among patients with HIV/AIDS: The schedule of attitudes toward hastened death. American Journal of Psychiatry, 156, 9499.

Seale, C. & Addington-Hall, J. (1994). Euthanasia: Why people want to die earlier. Social Science of Medicine, 39, 647654.

Snaith, R.P. (2003). The Hospital Anxiety and Depression Scale. Health and Quality of Life Outcomes, 1, 29.

Spinhoven, P.H., Ormel, J., Sloekers, P.P.A., et al. (1997). A validation study of the Hospital Anxiety and Depression Scale (HAD) in different groups of Dutch subjects. Psychological Medicine, 27, 363370.

Suarez-Almazor, M.E., Newman, C., Hanson, J., et al. (2002). Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. Journal of Clinical Oncology, 20, 21342141.

Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *