Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue

Abstract

There is little agreement about what constitutes good death or successful dying. The authors conducted a literature search for published, English-language, peer-reviewed reports of qualitative and quantitative studies that provided a definition of a good death. Stakeholders in these articles included patients, prebereaved and bereaved family members, and healthcare providers (HCPs). Definitions found were categorized into core themes and subthemes, and the frequency of each theme was determined by stakeholder (patients, family, HCPs) perspectives. Thirty-six studies met eligibility criteria, with 50% of patient perspective articles including individuals over age 60 years. We identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spiritualty, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with HCP, and other. The top three themes across all stakeholder groups were preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%). However, some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion (80%), quality of life (70%), dignity (70%), and presence of family (70%) more frequently than did patient perspectives regarding those items (35%–55% each). In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives (65%) than in family perspectives (50%). Taking into account the limitations of the literature, further research is needed on the impact of divergent perspectives on end-of-life care. Dialogues among the stakeholders for each individual must occur to ensure a good death from the most critical viewpoint—the patient’s.

Reflections on wisdom at the end of life: qualitative study of hospice patients aged 58–97 years

“…This same process may be mirrored in the actions of patients' loved ones, and may even be seen among staff as they aim to actively accept patients' mortality, yet simultaneously work hard to improve the lives of the patients and their families on a daily basis (Meier et al, 2016). In some respects, perhaps this "seesaw" concept is similar to the balance described in the Serenity Prayer: "Lord, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference" (Niebuhr, 2015).…”

Nurse Practitioner Perspectives on the Barriers and Facilitators of Advance Care Planning

“…A systematic review by Meier et al (2016) was conducted to uncover what a good death or successful dying means from the perspectives of patients, families and healthcare providers. The researchers selected 36 relevant articles; 27 qualitative studies, 5 quantitative studies and 4 mixed methods studies.…”

“…Dignity was described as being respected and maintaining independence. The theme of family contained subthemes such as family support, family acceptance for the death and not being a burden to family (Meier et al, 2016).…”

“…The most common themes among health care providers were preference for the dying process, pain-free status, dignity and emotional well-being (Meier et al, 2016). The systematic review provided insight into what is most important to patients and families in the dying process.…”

Common or multiple futures for end of life care around the world? Ideas from the ‘waiting room of history’

“…It is widely acknowledged that hospice and palliative care might become a form of institutionalised ‘good death’ (McNamara et al., 1994, McNamara, 2004). One review of 36 studies where participants included patients, family members, and healthcare providers identified 11 core themes of good death of which the top three were: preferences about the dying process (94% of reports), pain-free status (81%), and emotional well-being (64%) (Meier et al., 2016). …”