We aimed to address the prevalence of desire-to-die statements (DDSs) among terminally ill cancer patients in an acute palliative care unit. We also intended to compare the underlying differences between those patients who make desire-to-die comments (DDCs) and those who make desire-for-euthanasia comments (EUCs).

We conducted a one-year cross-sectional prospective study in all patients receiving palliative care who had made a DDC or EUC. At inclusion, we evaluated symptom intensity, anxiety and depression, and conducted a semistructured interview regarding the reasons for these comments.

Of the 701 patients attended to during the study period, 69 (9.8%; IC95% 7.7–12.3) made a DDS: 51 (7.3%) a DDC, and 18 (2.5%) an EUC. Using Edmonton Symptom Assessment Scale (ESAS) DDC group showed higher percentage of moderate-severe symptoms (ESAS > 4) for well-being (91 vs. 25%; p = 0.001), depression (67 vs. 25%; p = 0.055), and anxiety (52 vs. 13%; p = 0.060) than EUC group. EUC patients also considered themselves less spiritual (44 vs. 84%; p = 0.034). The single most common reason for a DDS was pain or physical suffering, though most of the reasons given were nonphysical.

Almost 10% of the population receiving specific oncological palliative care made a DDC (7.3%) or EUC (2.5%). The worst well-being score was lower in the EUC group. The reasons for both a DDC and EUC were mainly nonphysical. We find that emotional and spiritual issues should be identified and effectively addressed when responding to a DDS in terminally ill cancer patients.

To examine the attitudes of Iranian nurses toward caring for dying patients.

Nurses' attitudes toward death and caring for dying patients were examined by using two types of questionnaires: the Death Attitude Profile–Revised (DAP-R) and Frommelt's Attitude towards Caring for Dying Patients (FATCOD), both with a demographic survey.

The results showed that most respondents are likely to view death as a natural part of life and also as a gateway to the afterlife. The majority reported that they are likely to provide care and emotional support for the people who are dying and their families, but they were unlikely to talk with them or even educate them about death. They had a tendency not to accept patients and their families as the authoritative decision makers or involve families in patient care. Nurses' personal views on death, as well as personal experiences, affected their attitudes toward care of the dying.

Lack of education and experience, as well as cultural and professional limitations, may have contributed to the negative attitude toward some aspects of the care for people who are dying among the nurses surveyed. Creating a reflective narrative environment in which nurses can express their own feelings about death and dying seems to be a potentially effective approach to identify the factors influencing their interaction with the dying. Continuing education may be required for Iranian palliative care nurses in order to improve the patients quality of care at the end of life.