In search of a good death: Observations of patients, families, and providers

Despite a recent increase in the attention given to improving end-of-life c are, our understanding of what constitutes a good death is surprisingly lac king. The purpose of this study was to gather descriptions of the component s of a good death from patients, families, and providers through focus grou p 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 med ical center, a Veterans Affairs medical center, and a community hospice. Participants identified six major components of a good death: pain and symp tom management, clear decision making, preparation for death, completion, c ontributing to others, and affirmation of the whole person. The six themes are process-oriented attributes of a good death, and each has biomedical, p sychological, social, and spiritual components. Physicians' discussions of a good death differed greatly from those of other groups. Physicians offere d the most biomedical perspective, and patients, families, and other health care professionals defined a broad range of attributes integral to the qua lity 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 l ife. Biomedical care is critical, but it is only a point of departure towar d total end-of-life care. For patients and families, psychosocial and spiri tual issues are as important as physiologic concerns.