Exploring the underlying structural mechanisms and whole-person perspectives on the desire for hastened death in patients with terminal cancer: A qualitative study

This study provides the first comprehensive analysis of the underlying structural mechanisms of DHD in patients with terminal cancer from a whole-person perspective. DHD with spiritual pain is linked to the loss of future orientation, autonomy, and meaningful relationships through interconnected structural pathways, leading to feelings of worthlessness and existential meaninglessness. The identified framework demonstrates that these underlying mechanisms operate through an interplay of existential, relational, and autonomy-related factors extending beyond physical and psychological symptoms, reflecting an interconnected human experience across physical, psychological, social, and spiritual dimensions. This study established an evidence-based framework enabling healthcare professionals to implement whole-person approaches to recognize the multidimensional nature of DHD and address existential distress across all dimensions of human experience in end-of-life care.