How do you want to die? A good death means different things to different people, but psychiatrists recently identified 11 core themes they believe everyone will agree on when it comes to dying well.
After analyzing previous qualitative and quantitative studies on dying, researchers at the University of California, San Diego School of Medicine revealed that the top three core themes were preferences for specific dying process, pain-free status and emotional well-being.
Religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with the health care provider and "other" were the other themes of good death defined in the study.
Lead researcher Dilip Jeste said the latest study is important because it includes patients, family members and health care providers.
"This is the first time that data from all of the involved parties have been put together," said Jeste. "Death is, obviously, a controversial topic. People don't like to talk about it in detail, but we should. It's important to speak honestly and transparently about what kind of death each of us would prefer."
While preferences for specific dying process, pain-free status and emotional well-being were determined as the top themes for patients, family members and health care providers, other themes like religiosity and dignity differed in importance among different stakeholders.
"Some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion, quality of life, dignity and presence of family more frequently than did patient perspectives regarding those items," wrote researchers. "In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives than in family perspectives."
"Clinically, we often see a difference between what patients, family members and health care providers value as most important near the end of life," said Emily Meier, a psychologist at Moores Cancer Center at UC San Diego Health and first author of the study. "Ultimately, existential and other psychosocial concerns may be prevalent among patients, and this serves as a reminder that we must ask about all facets of care that are essential at the end of life."
"Usually, patients know what they want or need and there is relief in talking about it," Jeste said. "It gives them a sense of control. I hope these findings spur greater conversation across the spectrum. It may be possible to develop formal rating scales and protocols that will prompt greater discussion and better outcomes. You can make it possible to have a good death by talking about it sometime before."
The latest findings were published in the American Journal of Geriatric Psychiatry.
