Articles

Six Important Themes Identify “Good Death”
Themes are Central to Hospice of Southeastern Connecticut

A recent study has identified six key attributes of a good death, which researchers say may prove helpful to clinicians addressing end-of-life issues.

Researchers from Durham, N.C., convened focus groups from two medical centers and a community hospice, then conducted in-depth interviews. Stratified by role, the groups consisted of physicians, nurses, social workers, chaplains, hospice volunteers, patients and recently bereaved family members. The 75 participants were asked to discuss their experiences with the deaths of patients and loved ones and to consider what made those deaths good or bad.

Six Components of a Good Death

1. Pain and Symptom Management
   Many participants feared dying in pain or undergoing aggressive therapy with insufficient analgesia. There was concern about both current and future control of such symptoms as breakthrough pain and extreme air hunger. Reassurance from providers that these future symptoms would be managed was important to patients and families.
   
   Hospice caregivers are the recognized experts in pain and symptom control. 95% of our patients are pain free and at peace even at the end of life.
   
2. Clear Decision-Making
   Providers and families expressed the need for improved communications to avoid entering into a crisis situation without clear knowledge of the patient’s values and preferences. Patients felt empowered by being included in treatment decisions concerning their own illnesses.
   
   Hospice care is patient/family driven. They are free to make their own choices and decisions based on their personal values, needs and wishes.
   
3. Preparation for Death
   Patients wanted to know what to expect during their illness so they could plan ahead, arrange personal affairs or say goodbye. Both families and providers expressed the need for families to understand the physical and psychosocial changes that accompany the approach of death.
   
   Hospice patients/families are kept informed every step of the way. Throughout the course of the illness, they know what to expect even at the time of death.
   
4. Completion
   All non-physician groups emphasized the deep importance of spiritual and emotional meaningfulness at the end of life. Issues of belief, individual life review, conflict resolution, and time shared with loved ones were considered crucial aspects of the dying process.
   
   Non-denominational clergy and social workers are available to address the very important emotional, psychosocial and spiritual issues patients and families confront at the end-of-life.
   
5. Contributing to Others
   Dying patients wanted to feel included in human interactions and be allowed to reciprocate care. Ways of contributing to the well-being of others included sharing gifts, time, knowledge, or newly acquired understanding.
   
   Hospice care is provided in the home where patients have the opportunity to share with family and friends, say their good-byes and put their affairs in order.
   
6. Affirmation of the Whole Person
   Participants stressed the importance of approaching the terminally ill patient as a whole, unique person, rather than as just a case or “disease.” Providers appreciated their personal relationships with the dying, and patients expressed a desire to “simply be known.”
   
   Hospice care is a holistic approach that views each person as unique and is dedicated to preserving quality of life for whatever months or weeks may remain to the patient.

Source: In Search of Good Death: Observations of Patients, Families, and providers, Annals of Internal Medicine; May 16, 2000; 132(10);825-832.

Quotes from Family Members

• “We were able to enjoy several family events because Dad was home. He and mother celebrated their 48th wedding anniversary in September. We had many birthday parties in his room. That was also the place where we watched Dad’s Yankees win the World Series, and the grandchildren, with great enthusiasm, opened their Christmas gifts. And Dad got to see the new Millennium arrive. With the help of Hospice we were able to help Dad through his final days with love, compassion and dignity.”
  
• “Our sister passed away with a very peaceful look on her face and that memory will always stay with us.”
  
• “The nurse from Hospice did so much, but most importantly, she and the physician knew just the right amount of medication to manage my father’s pain.”