Table 4 Modifications of the semi-structured clinical approach based on Delphi comments
Contents of comments | Implementationa |
|---|---|
free text answers across all domains pointed to the need to provide general notes on proper usage of the clinical approach | added a new domain: ➪ ‘usage notes’ |
suggestion on asking whether patients think about terminating life prematurely criticized as being too direct | added 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 setup | changed 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 classification | added 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 words | changed wording: ➪ ‘Attempting to manipulateinfluence family or health professionals’ |
“attracting attention” in the respective function of desire to die seen to be poor choice of words | changed 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 worded | changed 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 narrow | added 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’ |