Researchers define the elements of a ‘good death’
A good life is easy to imagine, but what constitutes a good death?
Researchers at the University of California, San Diego School of Medicine identified 11 core themes associated with dying well. The findings are published in the April 2016 issue of the American Journal of Geriatric Psychiatry.
Through looking at 32 qualifying studies, researchers identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and “other.”
The top three themes across all stakeholder groups were preferences for specific dying process, pain-free status and emotional well-being. For other themes, however, different stakeholders put somewhat different levels of emphasis. For example, patients more often cited religiosity/spirituality as important than did family members, who believed dignity and life completion were more critical to a good death. Health care providers tended to represent a middle ground between patients and family members.
“Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life,” said first author Emily Meier, PhD, a psychologist at Moores Cancer Center at UC San Diego Health. “Ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life.”
The bottom line, said Jeste, is “ask the patient.”
“Usually, patients know what they want or need and there is relief in talking about it. It gives them a sense of control. I hope these findings spur greater conversation across the spectrum. It may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before.”
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