title: Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer.
abstract: OBJECTIVE
  Knowing how to improve the dying experience for patients with end-stage cancer is essential for cancer professionals. However, there is little evidence on the relationship between clinically relevant factors and quality of death. Also, while hospice has been linked with improved outcomes, our understanding of factors that contribute to a "good death" when hospice is involved remains limited. This study (1) identified correlates of a good death and (2) provided evidence on the impact of hospice on quality of death.
  
  
  METHODS
  Using data from a survey of US households affected by cancer (N = 930, response rate 51 %), we fit regression models with a subsample of 158 respondents who had experienced the death of a family member with cancer. Measures included quality of death (good/bad) and clinically relevant factors including: hospice involvement, symptoms during treatment, whether wishes were followed, provider knowledge/expertise, and compassion.
  
  
  RESULTS
  Respondents were 60 % female, 89 % White, and averaged 57 years old. Decedents were most often a respondent's spouse (46 %). While 73 % of respondents reported a good death, Hispanics were less likely to experience good death (p = 0.007). Clinically relevant factors, including hospice, were associated with good death (p < 0.05)--an exception being whether the physician said the cancer was curable/fatal. With adjustments, perceptions of provider knowledge/expertise was the only clinical factor that remained associated with good death.
  
  
  CONCLUSIONS
  Enhanced provider training/communication, referrals to hospice and greater attention to symptom management may facilitate improved quality of dying. Additionally, the cultural relevance of the concept of a "good death" warrants further research.
authors.affiliation: School of Social Work, University of Maryland, 525West Redwood Street, 3W13, Baltimore, MD, 21201, USA, jcagle@ssw.umaryland.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Cagle
authors.forename: Jolynn
authors.initials: J
authors.lastname: Pek
authors.forename: Maggie
authors.initials: M
authors.lastname: Clifford
authors.forename: Jack
authors.initials: J
authors.lastname: Guralnik
authors.forename: Sheryl
authors.initials: S
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003142:Communication; D003469:Culture; D003625:Data Collection; D003643:Death; D005190:Family / Q000523:psychology; D005260:Female; D017051:Hospice Care / Q000592:standards*; D006738:Hospices / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D010166:Palliative Care / Q000592:standards; D011368:Professional-Family Relations