Abstract:
Substantial research has shown deficits in the quality of end-of-life care in the U.S. In response to evidence of these deficits, efforts have been made to improve quality of end-of-life care. One approach has been to ask the question, "What is a good death?" Data on views of a good death from populations outside the health care system are nonexistent. In this exploratory study, we analyzed existing qualitative data on dimensions of a good death from a large sample to describe evidence of common dimensions of a good death and addressed whether those dimensions varied by age. A secondary analysis of existing survey data from five U.S. states was conducted to examine adult community members' (N = 2,295) views of a good death. Responses to an open-ended question from the Missoula Demonstration Project Community Survey, an unpublished, 73-item survey on individual's views and experiences with death, dying, and preferences of end-of-life care, provided the data for the study. Six broadly themed domains of process-oriented elements of a good death were derived. The five domains of Physical State, Spiritual/Emotional Needs, Relationship Needs, Dying Environment, and Religious Needs concur with themes established in the literature. In addition, a new domain, Predeath Needs was identified. Physical State was overwhelmingly the most prominent theme (74%, n = 1,513) in the sample. Most respondents reported some aspect of a person's physical state while dying (e.g., pain management, symptom control, etc.) as a component of a good death. Chi Square tests were conducted on frequency of themes across age cohorts. Differences between observed and expected counts for all themes, except for Religious Needs, were statistically significant (p < .05) suggesting that there are age differences among themes. The results of this study indicate that broad common domains of a good death can be derived from a sample of community-residing adults. The study's findings also support the prevailing view of recognizing specific individual needs for a good death, and suggest further that those themes may be prioritized differently among cohorts. The findings on Physical State suggest a need for changes in how pain is addressed within the clinical setting, and the need to understand how pain is perceived and managed individually, culturally, and within the broader medical system. Enhancements for patient care may include improvement in current medical practices in pain management and providers' increased willingness to care for and communicate with dying individuals, and integrate those aspects in a persons' dying process.
