Palliative Home Care Nurses' Experiences of End-of-Life Patients Expressing a Wish to Die: A Qualitative Content Analysis.

Abstract

Expressions of a wish to die among patients with advanced illness represent a complex and ethically challenging phenomenon within palliative care. Nurses working in advanced healthcare in patients' homes are often at the forefront of responding to such expressions in a setting characterized by close relationships and prolonged engagement. The aim of this study was to examine nurses' experiences of caring for end-of-life patients who express a wish to die. A qualitative descriptive design was adopted. Semi-structured interviews were conducted with nine registered nurses working in advanced healthcare in patients' homes in Sweden. Data were analysed using qualitative content analysis, combining an initial deductive phase informed by the Six S model of person-centred palliative care with a subsequent inductive analysis. One overarching theme was identified: Alleviating suffering by engaging with the patient's lifeworld. Nurses interpreted expressions of a wish to die primarily as communicative acts reflecting multidimensional suffering, including physical pain, anxiety, existential distress, and loss of meaning. Four generic categories described how nurses responded through symptom relief, support for meaning-making, collaboration with relatives and the interdisciplinary team, and preservation of patient autonomy. Rather than indicating a stable desire to end life, nurses understood patients' expressions of a wish to die as manifestations of suffering that could be alleviated through person-centred, relational, and symptom-focused care. The findings highlight the central role of nurses in palliative home care and contribute nursing-specific knowledge to the international literature on end-of-life care.