Perceptions of a 'good' death: a comparative study of the views of hospice staff and patients

Abstract

The literature suggests that health professionals working in palliative care have developed an idealised concept of dying which has been labelled the 'good' death. This paper reports the results of a preliminary qualitative study which compared the concepts of a 'good' death used by patients and staff in a palliative care unit. Semistructured interviews designed to elicit perceptions of 'good' and 'bad' deaths were conducted with 18 patients and 20 health professionals. The transcribed interviews were content analysed. There were major differences between the views of patients and staff. The patients' descriptions of a "good' death were diverse and included: dying in one's sleep, dying quietly, with dignity, being pain free and dying suddenly. In comparison, staff characterised a "good' death in terms of adequate symptom control, family involvement, peacefulness and lack of distress, while a "bad' death was described as involving uncontrolled symptoms, lack of acceptance and being young. The findings suggest that patients and staff differ in their conceptualisations of a "good' death.

‘Good’ and ‘bad’ deaths: Narratives and professional identities in interviews with hospice managers

“…As previous studies have also found (e.g. Low and Payne, 1996;Payne et al, 1996), there was considerable consensus in how our interviewees characterized both 'good' and 'bad' deaths. A 'good' death is described primarily in terms of peacefulness, symptom control, frank conversations, acceptance and openness to physical and emotional support.…”

“…We also show that these narratives have some distinctive formal characteristics, especially in terms of the starting point and core of the action, the use of personal pronouns and metaphors, and the ways in which positive or negative evaluation is expressed. Additionally, we point out that, as noted by Payne et al (1996), the view of what constitutes a 'good' death is remarkably consistent across our interviewees. We suggest that these characteristics reflect and support a strong sense of professional worth and identity, which is undoubtedly helpful for hospice staff performing their difficult roles.…”

Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life

“…36 It thus reflects the core components of a particular professional ideology and commitment to the nature and achievement for all patients of a particular construct of 'the good death'. [37][38][39][40] This involves the excellent control of symptoms within a holistic approach to care, which acknowledges death as a natural, rather than a pathological, process. It incorporates a commitment to open awareness and communication about dying between all participants: patient, family and professionals.…”

“…ACP has developed within a cultural and professional ideology combining commitment to the value of individual autonomy and choice and a practice of palliative care promoting a particular vision of 'the good death'. 38,39 The good death is a professionally brokered experience and focuses on the patient being comfortable, free from pain, in her or his preferred place and accompanied by family and significant others. An open awareness of dying enables communication and transparency about the circumstances of death.…”

Evaluating the Quality of Dying and Death

“…34 We searched the literature and selected studies of dying patients that addressed the conceptual domains or used measures to assess quality of life or quality of dying. 5,20,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] Concepts and domains from these measures were identified and listed for possible inclusion into the conceptual model and operational definition.…”