title: Critical events in the dying process: the potential for physical and psychosocial suffering.
abstract: BACKGROUND
  Understanding what aspects of the dying process motivate terminally ill individuals to consider hastening their death, can lead to improving end-of-life care.
  
  
  OBJECTIVE
  Advance knowledge regarding critical events within the dying process that have the potential to give rise to physical and psychosocial suffering such that an elder wishes for or considers a hastened death.
  
  
  METHODS
  Face-to-face in-depth qualitative interviews conducted with 96 terminally ill elders, 15 of whom discussed an event in their dying process that resulted in suffering so great they wished for, or considered, a hastened death. Data were content analyzed to identify and categorize the main themes and patterns involved in these elders' experiences.
  
  
  METHODS
  The interviews were conducted on palliative care hospital units, and in outpatient clinics, free standing hospice facilities, and home hospice.
  
  
  RESULTS
  Four critical events emerged: perceived insensitive and uncaring communication of a terminal diagnosis; experiencing unbearable physical pain; unacknowledged feelings regarding undergoing chemotherapy or radiation treatment; and dying in a distressing environment. Respondents discussed physical and/or psychosocial suffering that occurred at these events, and the end-of-life care practices that reduced their suffering.
  
  
  CONCLUSIONS
  Awareness of events common to the dying process, the potential physical and psychosocial suffering that may arise at these events, and the end-of-life care practices associated with reducing that suffering can lead to health care professionals being able to take a proactive rather than reactive approach to end-of-life care.
authors.affiliation: School of Social Work, University of Wisconsin-Madison, 1350 University Avenue, Madison, WI 53706, USA. tschroepfer@wisc.edu
authors.forename: Tracy A
authors.initials: TA
authors.lastname: Schroepfer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005065:Euthanasia / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009042:Motivation; D010146:Pain / Q000209:etiology; D010166:Palliative Care / Q000523:psychology*; D036301:Qualitative Research; D019452:Terminally Ill / Q000523:psychology*