Assessing suicidal thoughts in the terminally ill

Several studies have shown that the prevalence of suicidal thoughts among patients with terminal cancer is less than 10 per cent. (2°) However, this contradicts the clinical impression that most patients admit to either suicidal thoughts or thoughts of assisted suicide as an escape from the imaged consequences of losing control. In some patients, having a belief in a 'way out' can be positive in offering a sense of control.

Completed suicide is an important complication in patients with a terminal illness. General predictors of suicide apply, with the addition of severity of functional impairment, isolation, and delirium. The two most important factors to watch out for are uncontrolled pain and depression. These two factors greatly increase suicide risk but are nevertheless treatable in the terminal illness setting.

People who express a desire to die are nearly always ambivalent. In our view the expression of suicidal ideas should never be accepted as rational without a searching enquiry for evidence of subtle external pressures, fear of terminal symptoms, and treatable depression.

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