The Human Experience of a Good Death: Journal Article 

The article “In search of a good death: observations of patients, families, and providers” published in Annals of Internal Medicine in 2000, explores the perspectives of patients, families, and providers on what constitutes a good death. The study aimed to identify key themes that emerged from these observations and to highlight areas where interventions could be made to improve the quality of end-of-life care.  

The authors conducted a qualitative study using open-ended interviews with 62 patients with life-limiting illnesses, their families, and 38 providers, including physicians, nurses, social workers, and chaplains. The participants were asked to describe what they believed constituted a good death, and their experiences in achieving or facilitating it. The data were analyzed using a grounded theory approach. 

The study identified several key themes that emerged from the interviews. The first was the importance of having control over the dying process. Many patients expressed a desire to be in control of their care and decision-making, and to have a sense of autonomy in the face of their illness. The second theme was the need for effective communication between patients, families, and providers. Patients and families highlighted the importance of clear and honest communication, and the need for providers to listen actively and respond to their concerns.  

The third theme was the importance of achieving a sense of closure and meaning in the dying process. Patients and families expressed a desire to make sense of their experiences and to find meaning in their illness. Steinhauser, Clipp, McNeilly, et al define a sense of closure and meaning in the dying process as a desire for patients and families to make sense of their experiences and to find meaning in their illness. This may involve resolving any unfinished business or saying goodbye to loved ones, as well as finding a sense of peace or acceptance with the dying process. It may also involve exploring spiritual or existential questions and finding a sense of purpose or legacy in the face of death. Overall, the study suggests that achieving a sense of closure and meaning is an important aspect of a good death for many patients and families. 

Steinhauser, Clipp, McNeilly, et al highlighted several areas where interventions could be made to improve the quality of end-of-life care. One area was the need for providers to be better trained in communication skills, particularly in how to address patients’ emotional and spiritual needs. Providers should encourage patients and families to express their concerns, fears, and goals, and should respond with empathy and honesty. Use clear and simple language by avoiding medical jargon and use clear, simple language to explain medical information and treatment options. Tailor communication to the patient’s preferences. Explore how the family prefer the delivery of information, and whether they want to be involved in decision-making. The whole interdisciplinary care team should provide ongoing communication and support throughout the dying process, including providing updates on the patient’s condition and being available to answer questions. 

Another area was the need for greater support for families, both during the dying process and in the aftermath of death and provides practical recommendations for providers to improve support for families. Providers should encourage family involvement in decision-making and care planning, and should provide information and resources to help families support their loved ones. Provide emotional support including counseling, spiritual guidance and support groups, to help families cope with the stress and grief of the dying process. Providers should be aware of and respectful of the cultural and spiritual needs of patients and families, and provide resources and support to address these needs. Address practical needs such as financial and legal concerns, and provide assistance with practical tasks such as transportation and meal preparation. Recognize that families will require access to ongoing support to families after the patient’s death, including bereavement support and referrals to community resources. 

Finally, the study suggested that greater attention needed to be paid to the physical environment in which end-of-life care takes place, including the need for comfortable and private spaces where patients and families can have meaningful interactions with adequate space for visitors and amenities such as comfortable chairs and refreshments. Allowing for personalization: Providers should allow patients and families to personalize their surroundings, such as by bringing in personal items or pictures. Minimizing noise and disruptions as by providing sound-proofing or limiting the number of people entering the room. Allowing for natural light and access to nature or outdoor spaces. Maintaining consistent environmental elements has been shown to have a positive effect on mood and well-being. 

In conclusion, the study by Steinhauser, Clipp, McNeilly, et al. sheds light on what patients, families, and providers believe constitutes a good death. The study identifies several key themes, including the importance of control over the dying process, effective communication, and achieving a sense of closure and meaning. The study also highlights areas where interventions could be made to improve the quality of end-of-life care, including the need for provider training in communication skills, greater support for families, and attention to the physical environment of care. These findings have important implications for counseling aimed at improving end-of-life care and for the delivery of clinical care to patients and families facing life-limiting illnesses. 

 

Reference: 

Authors: Steinhauser, K.; Clipp, E.C.; McNeilly, M.; et al. 
Title: In search of a good death: observations of patients, families, and providers. 
Journal: Annals of Internal Medicine. 
Year of publication: 2000. 
Volume number: 132. 
Pages: 825-832. 

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