title: In search of a good death: observations of patients, families, and providers.
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.
authors.affiliation: Durham Veterans Affairs Medical Center, North Carolina 27705, USA. karensteinhauser@mindspring.com
authors.forename: K E
authors.initials: KE
authors.lastname: Steinhauser
authors.forename: E C
authors.initials: EC
authors.lastname: Clipp
authors.forename: M
authors.initials: M
authors.lastname: McNeilly
authors.forename: N A
authors.initials: NA
authors.lastname: Christakis
authors.forename: L M
authors.initials: LM
authors.lastname: McIntyre
authors.forename: J A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D001293:Attitude to Death; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D010361:Patients / Q000523:psychology*; D036301:Qualitative Research; D012106:Research; D013727:Terminal Care