The aim of this study was to develop a measure for evaluating good death from the bereaved family member's perspective, and to examine the validity and reliability of the assessment. A cross-sectional anonymous questionnaire was administered to bereaved family members of cancer patients who had died in a regional cancer center from September 2004 to February 2006. We measured the Good Death Inventory (GDI), Care Evaluation Scale, and an overall care satisfaction scale. A retest was conducted one month after sending the questionnaire. Of the 344 questionnaires sent to bereaved family members, 189 responses were analyzed (57%). A factor analysis of the responses to the GDI identified 10 core domains: ''environmental comfort,'' ''life completion,'' ''dying in a favorite place,'' ''maintaining hope and pleasure,'' ''independence,'' ''physical and psychological comfort,'' ''good relationship with medical staff,'' ''not being a burden to others,'' ''good relationship with family,'' and ''being respected as an individual.'' Eight optional domains also were identified: ''religious and spiritual comfort,'' ''receiving enough treatment,'' ''control over the future,'' ''feeling that one's life is worth living,'' ''unawareness of death,'' ''pride and beauty,'' ''natural death,'' and ''preparation for death.'' The GDI had sufficient concurrent validity with the Care Evaluation Scale and overall care satisfaction, sufficient internal consistency (alpha ¼ 0.74e0.95), and acceptable testeretest reliability (ICC ¼ 0.38e0.72). Finally, we developed a short version of the GDI. The GDI is a valid scale to measure end-of-life care comprehensive outcomes from the bereaved family member's perspective in Japan. J Pain Symptom Manage

The main findings of this study were: (1) overall, bereaved family members were satisfied with end-of-life care in all three places of death; (2) designated cancer centers were inferior to PCUs and home hospices and had more room for improvement; and 3) home hospices were rated higher than PCUs for achieving a good death, although home hospices remain uncommon in Japan.

Knowledge, difficulty and self-reported practice for symptom management, particularly psychological symptoms, were insufficient, particularly in community hospitals. Education, expert support and adequate clinical experiences would help provide quality palliative care.