In search of a good death: observations of patients, families, and providers

Ann Intern Med. 2000 May 16;132(10):825-32. doi: 10.7326/0003-4819-132-10-200005160-00011.

Abstract

Despite a recent increase in the attention given to improving end-of-life care, our understanding of what constitutes a good death is surprisingly lacking. The purpose of this study was to gather descriptions of the components of a good death from patients, families, and providers through focus group discussions and in-depth interviews. Seventy-five participants-including physicians, nurses, social workers, chaplains, hospice volunteers, patients, and recently bereaved family members-were recruited from a university medical center, a Veterans Affairs medical center, and a community hospice. Participants identified six major components of a good death: pain and symptom management, clear decision making, preparation for death, completion, contributing to others, and affirmation of the whole person. The six themes are process-oriented attributes of a good death, and each has biomedical, psychological, social, and spiritual components. Physicians' discussions of a good death differed greatly from those of other groups. Physicians offered the most biomedical perspective, and patients, families, and other health care professionals defined a broad range of attributes integral to the quality of dying. Although there is no "right" way to die, these six themes may be used as a framework for understanding what participants tend to value at the end of life. Biomedical care is critical, but it is only a point of departure toward total end-of-life care. For patients and families, psychosocial and spiritual issues are as important as physiologic concerns.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Advance Care Planning
  • Aged
  • Attitude to Death*
  • Decision Making
  • Family / psychology*
  • Female
  • Focus Groups
  • Health Personnel / psychology*
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Pain / prevention & control
  • Patients / psychology*
  • Qualitative Research
  • Research
  • Terminal Care*