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16 May 2000 | Volume 132 Issue 10 | Pages 825-832
Despite a recent increase in the attention given to improving end-of-life care, our understanding of what constitutes a good death is surprisingly lacking. The purpose of this study was to gather descriptions of the components of a good death from patients, families, and providers through focus group discussions and in-depth interviews. Seventy-five participants—including physicians, nurses, social workers, chaplains, hospice volunteers, patients, and recently bereaved family members—were recruited from a university medical center, a Veterans Affairs medical center, and a community hospice.
Participants identified six major components of a good death: pain and symptom management, clear decision making, preparation for death, completion, contributing to others, and affirmation of the whole person. The six themes are process-oriented attributes of a good death, and each has biomedical, psychological, social, and spiritual components. Physicians' discussions of a good death differed greatly from those of other groups. Physicians offered the most biomedical perspective, and patients, families, and other health care professionals defined a broad range of attributes integral to the quality of dying.
Although there is no "right" way to die, these six themes may be used as a framework for understanding what participants tend to value at the end of life. Biomedical care is critical, but it is only a point of departure toward total end-of-life care. For patients and families, psychosocial and spiritual issues are as important as physiologic concerns.
Author and Article Information
From the Durham Veterans Affairs Medical Center, Duke University, and the Institute for Multiculturalism, Durham, North Carolina; and University of Chicago, Chicago, Illinois.
Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Acknowledgments: The authors thank Ginette Nachman for transcription support; Aileen Ward for focus group facilitation; and the 75 patients, family members, and health care providers who graciously shared their experiences of care at the end of life.
Grant Support: By the Veterans Affairs Health Services Research and Development (96-006). Dr. Tulsky and Dr. Christakis were Project on Death in America Soros Faculty Scholars. Dr. Tulsky is supported by a Veterans Affairs Health Services Research Career Development Award and a Robert Wood Johnson Generalist Physician Faculty Scholars Award.
Requests for Single Reprints: Karen E. Steinhauser, PhD, Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705; e-mail, karensteinhauser{at}mindspring.com.
Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.
Current Author Addresses: Drs. Steinhauser, Clipp, McIntyre, and Tulsky: Veterans Affairs Medical Center (152), 508 Fulton Street, Durham, NC 27705.
Dr. McNeilly: Duke University Medical Center, Box 3003, Durham, NC 27710.
Dr. Christakis: University of Chicago, 5841 South Maryland Avenue, MC2007, Chicago, IL 60637. PERSPECTIVE
In Search of a Good Death: Observations of Patients, Families, and Providers
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