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

  • Steinhauser K
  • Clipp E
  • McNeilly M
 et al. 
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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

Author-supplied keywords

  • Adult
  • Advance Care Planning
  • Aged
  • Attention
  • Attitude to Death
  • Death
  • Decision Making
  • Family
  • Female
  • Focus Groups
  • Health Personnel
  • Human
  • Interviews
  • Male
  • Middle Aged
  • Nurses
  • Observation
  • Pain
  • Patients
  • Physicians
  • Qualitative Research
  • Research
  • Support,Non-U.S.Gov't
  • Support,U.S.Gov't,Non-P.H.S.
  • Terminal Care
  • Universities
  • Veterans
  • end-of-life care
  • prevention & control
  • psychology

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  • PMID: 10819707

Authors

  • K E Steinhauser

  • E C Clipp

  • M McNeilly

  • N A Christakis

  • L M McIntyre

  • J A Tulsky

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