Dying well after discontinuing the life-support treatment of dialysis

Background: Cessation of life-prolonging treatments precedes death in an in creasing number of cases, but little attention has been accorded to the qua lity of dying. Objective? To examine the quality of dying following dialysis termination. Patients and Methods: A prospective cohort, observational study involved 6 dialysis clinics in the United States and 2 clinics in Canada, and 131 adul t patients receiving maintenance dialysis who died after treatment cessatio n. Sixty percent (n=79) underwent patient (n=23) and/or family (n=76) inter views and follow-up with caretakers. A quality of dying tool quantified dur ation; pain and suffering, and psychosocial factors. Results: The sample was 59% female, the age was 70.0+/-1.2 years old, the d uration of dialysis was 34.0+/-2.8 months, and death occurred 8.2+/-0.7 day s after the last dialysis treatment. (Data are given as mean+/-SE.) Thirty- eight percent of the subjects who completed the protocol were judged to hav e had very good deaths, 47% had good deaths, and 15% had bad deaths. During the last day of life, 81% of the sample did not suffer, although 42% had s ome pain and an additional 5% had severe pain. According to the psychosocia l domain of the quality of dying measure, patients who died at home or with hospice care had better deaths than those who died in a hospital or nursin g home. Conclusions: Most deaths following withdrawal of dialysis were good or very good. The influence of site of death and physician attitudes about decisio ns to stop life support deserves more research attention. Quality of dying tools can be used to establish benchmarks for the provision of terminal car e.