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Table 4 Modifications of the semi-structured clinical approach based on Delphi comments

From: The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

Contents of commentsImplementationa
free text answers across all domains pointed to the need to provide general notes on proper usage of the clinical approachadded a new domain:
➪ ‘usage notes
suggestion on asking whether patients think about terminating life prematurely criticized as being too directadded a new suggestion:
➪ ‘Explore thoughts related to not wanting to live anymore
clinical approach seen to be at danger of provoking checklist type of interrogation due to bullet point setupchanged interrogative clauses to instructions:
‘Exists or existedExplore fear of death and dying?’
‘Exists or existedExplore thoughts related to terminating life prematurely?
complexity and changeability of desire to die in palliative patients seen to run counter to unambiguous classificationadded a new suggestion:
➪ ‘In general, keep in mind: desire to die is complex and prone to change
“manipulate” in the respective function of desire to die seen to be poor choice of wordschanged wording:
➪ ‘Attempting to manipulateinfluence family or health professionals’
“attracting attention” in the respective function of desire to die seen to be poor choice of wordschanged wording:
➪ ‘AttractingDrawing attention to oneself and one’s trouble
“treatment contracts” seen as bad practice, especially when involving handshakes for sealing the contract as it seemed to suggest “clean hands practice”changed wording, rated old and new version during round 2:
➪ ‘Entering into a treatment contract with handshake in cases of latent suicidality’ (32.9% agreement, M = 3.00, SD = 1.19)
➪ ‘Entering into a treatment contract with handshakeagreement in cases of latent suicidality in order to win time for interventions’ (79.2% agreement, M = 4.17, SD = 0.96)
suggestion on passive euthanasia seen as poorly wordedchanged wording:
➪ Letting die (passive euthanasia) as a legal option (foregoing, restriction or cancellation of life sustaining and life prolonging measures)
selection of therapeutic approaches listed as examples in respective suggestions seen as too narrowadded a new suggestion during round 2:
➪ ‘Offering other (psycho-)therapeutic interventions (e.g. family therapy, psychotherapy, art therapy)’ summed up all related suggestions into one for the finalized clinical approach:
➪ ‘Offering counseling or (psycho-)therapy for individuals or groups
  1. aplain text: same wording in round 1 and 2; bold italic: deletions; underlined: additions