What makes a “good” death?

What makes a “good” death?

People want control over their lives, and that feeling doesn’t stop… even when they are nearing the end.

That’s one takeaway from a new study, published in the American Journal of Geriatric Psychiatry, that delved into the controversial topic of what defines a “good death.”

Researchers reviewed 36 international studies in which patients, their families and health care providers offered their views on end-of-life and what was most important Throughout the research, 11 core themes of “successful dying” emerged, including pain-free treatment, emotional well-being, dignity, quality of life and relationship with their hospital. More than half of patients interviewed were at least 60 years-old.

“The take-home, to me, is that we really need to talk to patients about the dying process,” said Dr. Dilip Jeste, senior researcher on the study, in a news release. “Even if patients want to talk about it, they may be afraid to bring it up with their families because they don’t want to upset them.”

With dying process (94 percent), pain-free status (81 percent) and emotional well-being (64 percent) polling as the top three concerns, many medical experts believe it’s necessary to have the tough talk, as challenging as it may be.

“Death is not an easy topic because a lot of family members don’t want to confront the difficult issue,” says Dr. Harley Brooks, medical director of care management and a physician advisor at Advocate Trinity Hospital in Chicago. “But it can’t be a conversation that we shy away from as family members.”

Researchers recommend that having a good dialogue before a family member falls ill can help ensure the best dying process. Sometimes there can be a disconnect, with doctors often more focused on pain control and patients’ preferences for how and where they die, and less focused on the existential – a sense of life completion and spirituality – which may be important to patients.

“It’s really essential that families start the process of talking about their end-of-life plans, which can include if they want their lives prolonged by a ventilator or if they want other measures,” says Dr. Brooks. “It’s extremely tough to have those conversations for the first time when everything is happening at a hospital.”

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Comments

5 Comments

  1. Kimberly Lange April 4, 2016 at 1:34 pm · Reply

    I was very excited to see a topic in health news on end of life and what makes a “good death” but I was disappointed in reading the article. Although a lot of good information was relayed Hospice was never mentioned. Advocate at Home has an incredible Hospice program and team that address all of the concerns brought up in the article and from the study.

    The Advocate Hospice team have specially trained staff who do Advanced Care Planning. As Dr. Brooks said it is so important to have started this discussion before a loved one is in the hospital and these hard decisions need to be made. A Registered Nurse, Social worker or other trained professional can go to the patient’s home to facilitate discussions on topics such as advanced directives, power of attorney for health care, options for care available as disease processes continue and care needs change. Advance directives including would you want artificial ventilation or artificial feedings, and who do you want to be your advocate when you cannot speak for yourself can be addressed. The Advance Care planning professional can even help to fill out documents and forms such as a health care power of attorney. They explain all the level of care options available from Hospital, Skilled Nursing Facilities, Home Care, and Palliative to Hospice Services if they family wants this information.

    Hospice Liaisons are present at most all Advocate Hospitals. The liaisons are trained to educate families and patient on end of life care and ease the transition from aggressive care to hospice care if the patient and family choose this option. The liaisons are available to be utilized to speak with patients and families about comfort care including the top three concerns listed from the study. The liaisons educate on the dying process so the family and patient are aware of what to expect as the patient progresses in his or her journey to death. Hospice has a team to provide support, including social workers and chaplains who help to address the emotional and spiritual concerns with end of life care and also support the families with the grieving and bereavement process. Hospice staff are experts in symptom management at end of life. With a team approach hand in hand with the patient, family, primary physicians, Hospice medical directors and direct care staff the patient can be kept comfortable and pain free as possible.

  2. Glenda m johnson April 4, 2016 at 4:28 pm · Reply

    All that has been said is true for me Dr. Brooks has made very good points and we tend to not want to talk about or we can’t afford for an advocate to come to the home and assist us with the preparation so we don’t do it. We may say things like I don’t have the money that . If there are services out there that are free and they are willing to walk them through such a process then I think it time the flyers are placed in the mail. Some may throw them away some may sit on the table until a family member reads and discuss and some will be answered. It all about planning and making sure that there last wishes are carried out to the letter.

  3. Lorenzo Jackson April 5, 2016 at 11:01 am · Reply

    Excellent topic. I am encouraged to discuss this topic with my family.

  4. Jessica Potas-Biewer April 6, 2016 at 6:05 pm · Reply

    Too many doctors in critical care units shy away from being direct, even when asked for directness by family so they can try to wrap their head around the true status of a loved one. Sadly, this led to more pain and suffering for my father. We would have done hospice if we were given clear information. My heart still hurts over this, as my dad did not deserve the situation he was placed in due to our ignorance of how grim things really were 🙁

  5. The topic is very fragile to discuss with grieving family. However, it is very important and unavoidable to inform the patient’s immediate family that the patient may not live longer, even with a ventilator support and they should take appropriate decision to reduce the pain and anxiety for their beloved ones. I have seen many families procrastinating this very crucial decision causing avoidable pain and anguish to their loved ones. They think by delaying this decision they are showing more love towards the beloved one but ignoring the fact that the patient is suffering unnecessarily for a long time due to squabble amongst the family members. They attending physicians should address this issue courageously and inform the truth even if it is not a acceptable to the family members,

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health enews Staff
health enews Staff

health enews staff is a group of experienced writers from our Advocate Aurora Health sites, which also includes freelance or intern writers.