Palliative Home Care Nurses’ Experiences of End-of-Life Patients Expressing a Wish to Die: A Qualitative Study

Background: The average life expectancy is increasing, and many individuals prefer to remain in their private homes until the end of their lives. This trend has led to a growing need for registered nurses to possess the competence to provide advanced healthcare to patients in private homes. Palliative care aims to alleviate suffering, enable the patient to live as normally as possible, and facilitate a peaceful death. However, caring for end-of-life patients who experience physical, mental, and spiritual pain can be professionally challenging for nurses. Purpose: This study aims to investigate the experiences of Advanced Health Care in Patients’ Homes (AHCPH) nurses in caring for end-of-life patients who no longer wish to live due to the suffering caused by severe illness. Methods: A descriptive design with a qualitative approach was employed, utilizing content analysis with an initial deductive approach followed by an inductive approach. Participants were purposively recruited from AHCPH teams in one Swedish city. Semi-structured interviews were conducted with nine informants, aged between 30 and 60 years, who had experience in palliative care. Results: The primary finding consists of the main theme derived from the latent content analysis: “Alleviating suffering by seeing/being part of the patient's lifeworld.” Four generic categories were identified: “Life suffering creates a death wish,” “Finding meaning to life through life strategies,” “Good care creates through participation,” and “Caring support helps the patients to experience quality of life”. Nurses observed that pain and anxiety were the primary drivers behind patients' death wishes. Effective symptom relief often transformed the desire to die into a desire to live. Conclusions: The study highlights the complex and emotionally challenging nature of caring for end-of-life patients who express a desire to die. AHCPH nurses play a crucial role in providing symptom relief, emotional support, and facilitating meaningful conversations with patients and their relatives. Addressing both physical and psychological aspects of care, supporting patient autonomy, and involving relatives in the care process are essential for enhancing the quality of life for end-of-life patients.