title: Clergy Views on a Good Versus a Poor Death: Ministry to the Terminally Ill.
abstract: BACKGROUND
  Clergy are often important sources of guidance for patients and family members making medical decisions at the end-of-life (EOL). Previous research revealed spiritual support by religious communities led to more aggressive care at the EOL, particularly among minority patients. Understanding this phenomenon is important to help address disparities in EOL care.
  
  
  OBJECTIVE
  The study objective was to explore and describe clergy perspectives regarding "good" versus "poor" death within the participant's spiritual tradition.
  
  
  METHODS
  This was a qualitative, descriptive study. Community clergy from various spiritual backgrounds, geographical locations within the United States, and races/ethnicities were recruited. Participants included 35 clergy who participated in one-on-one interviews (N = 14) and two focus groups (N = 21). Semistructured interviews explored clergy viewpoints on factors related to a "good death." Principles of grounded theory were used to identify a final set of themes and subthemes.
  
  
  RESULTS
  A good death was characterized by wholeness and certainty and emphasized being in relationship with God. Conversely, a "poor death" was characterized by separation, doubt, and isolation. Clergy identified four primary determinants of good versus poor death: dignity, preparedness, physical suffering, and community. Participants expressed appreciation for contextual factors that affect the death experience; some described a "middle death," or one that integrates both positive and negative elements. Location of death was not viewed as a significant contributing factor.
  
  
  CONCLUSIONS
  Understanding clergy perspectives regarding quality of death can provide important insights to help improve EOL care, particularly for patients highly engaged with faith communities. These findings can inform initiatives to foster productive relationships between clergy, clinicians, and congregants and reduce health disparities.
authors: 1 University of Virginia School of Nursing , Charlottesville, Virginia.
authors: Virginia T
authors: VT
authors: LeBaron
authors: 3 Beth Israel Deaconness Medical Center , Boston, Massachusetts.
authors: Amanda
authors: A
authors: Cooke
authors: 4 Boston University School of Theology , Boston, Massachusetts.
authors: Jonathan
authors: J
authors: Resmini
authors: 5 Boston College , Boston, Massachusetts.
authors: Alexander
authors: A
authors: Garinther
authors: 6 Brigham & Women's Hospital , Boston, Massachusetts.
authors: Vinca
authors: V
authors: Chow
authors: 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts.
authors: Rebecca
authors: R
authors: Quiñones
authors: 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts.
authors: Sarah
authors: S
authors: Noveroske
authors: 7 Harvard Divinity School , Boston, Massachusetts.
authors: Andrew
authors: A
authors: Baccari
authors: 8 Gordon-Conwell Theological Seminary , Boston, Massachusetts.
authors: Patrick T
authors: PT
authors: Smith
authors: 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts.
authors: John
authors: J
authors: Peteet
authors: 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts.
authors: Tracy A
authors: TA
authors: Balboni
authors: 2 Dana-Farber Cancer Institute, Harvard Cancer Center , Boston, Massachusetts.
authors: Michael J
authors: MJ
authors: Balboni
mesh_terms: D001741:Black or African American / Q000523:psychology; D001213:Asian / Q000523:psychology; D001293:Attitude to Death / Q000208:ethnology*; D002977:Clergy / Q000523:psychology*; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D010327:Pastoral Care; D057240:Patient Preference; D026684:Personal Autonomy; D028723:Personhood; D036301:Qualitative Research; D012068:Religion and Medicine; D013727:Terminal Care / Q000523:psychology* / Q000592:standards; D019452:Terminally Ill / Q000523:psychology*; D014481:United States; D044465:White People / Q000523:psychology