Understanding the concept of a 'good death' in Japan: differences in the views of doctors, palliative and non-palliative ward nurses

Stakeholders' perspectives of a good death: A qualitative study from Thailand

Background

A 'good death' is one of palliative care's main goals. However, there are different perspectives on what a good death is. Perspectives from three groups of people involved in the dying process: patients, caregivers, and healthcare providers; are crucial because how they interact will affect the overall quality of end-of-life care.

Objective

The aims were to 1) explore what is a good death and 2) how to achieve it from the perspectives of those involved in patient care.

Methods

A qualitative study was conducted between February to August 2019. The recruitment triad of stakeholders consisted of one patient with their primary caregiver and their physician. Interviews were conducted by researchers who had no prior relationship with the participants and were not a part of the healthcare team. Each research aim was analyzed separately using thematic content analysis. Data saturation was reached when no new or emerging themes emerged. Fourteen people were interviewed; five patients, five caregivers, and four physicians.

Results

Regarding perspectives of a good death, four themes emerged: 1: Peaceful natural progression and symptom-free, 2: Acceptance of death and dignity, 3: Readiness for death is facilitated by social support and the environment, and 4: Faith and religious values can bring peace. For the second research question regarding how to help the patient achieve a good death, three themes emerged: 1: provide supportive care, 2: good communication, and 3: prioritize the patients' wishes.

Conclusion

In the Thai context, the meaning of a good death relates to symptom control, acceptance of death, social support, and faith. However, a clear understanding of each individual's meaning of good death is required due to individualized needs and perceptions. Physicians and stakeholders looking to support good death should focus on providing supportive care, good communication, and prioritizing the patient's will and wishes.

The construction of the health professional in palliative care contexts: a scoping review on caring for the person at the end of life

AIM

The aim of the study was to map of the literature on the elements contributing to the construction of the health care professional in the context of palliative care.

METHODS

Scoping review based on Arksey and O'Malley framework. PubMed, Embase, CINAHL, Scopus databases, and gray literature were the sources searched (2005-2015), completed by reference searching, hand searching, and expert consultations. Primary studies focusing on different professionals working in palliative care units or hospice centers were eligible for inclusion.

RESULTS

From a total of 3632 articles, 22 met the inclusion criteria. The content of the studies was described and classified in 5 elements: (i) construction and application of the concept of care; (ii) psychosocial effects that the daily care produces; (iii) working conditions that influence the caregiving provided; (iv) knowledge mobilized in the provision of care; and (v) strategies adopted by health care professionals to build relationships. Data about nurses, physicians, and psychologists were found, but no data were found about social workers. Gaps identified in the publications were as follows: relationship competencies and strategies adopted; the real needs from educational programs; and the view of other professionals.

CONCLUSIONS

Key elements identified in the concept of the construction of the health care professional should be addressed in future interventions: prevention of emotional exhaustion, depersonalization, and achievement of a greater personal accomplishment. In addition, none of the articles retrieved offered the different perspectives of all the disciplines in a multidisciplinary team.

Understanding the concept of a “good death” among bereaved family caregivers of cancer patients in Singapore

Objective:

The aim of this study was to examine the concept of a good death from the perspectives of both the dying person and the family caregiver, as perceived by bereaved family caregivers of advanced cancer patients.

Method:

The data were gathered from five focus group discussions and one face-to-face qualitative interview conducted over 8 months among 18 bereaved family caregivers recruited from a local hospice. The transcripts of the focus groups and the interview were entered into NVivo Version 8 and were analyzed using the thematic approach.

Results:

A good death may be understood as having the biopsychosocial and spiritual aspects of life handled well at the end of life. Five major themes were identified. These were preparation for death, family and social relationships, moments at or near death, comfort and physical care, and spiritual well-being. Differences were also noted in what is important at the end of life between the patients and caregivers. Having a quick death with little suffering was perceived to be good by the patient, but the family caregiver wanted to be able to say a final goodbye to the patient. Patients tend to prefer not to die in their children's presence but the children wished to be present for the final moment. In addition, family caregivers reported it was important for them to be able to give the patients permission to die, to feel recognized for the efforts made, and to have had a fulfilling caregiving experience.

Significance of results:

Whereas there are global attributes of a good death, our findings suggest that patients and family caregivers may define a good death differently. Therefore, there is a need to respect, address, and reconcile the differences, so that all parties may have a good experience at the end of a person's life.

End-of-life needs as perceived by terminally ill older adult patients, family and staff

PURPOSE OF THE STUDY

A comparison of inpatient end-of-life needs as perceived by terminally ill older adult patients, family, physicians and nurses, is lacking. This study aimed to compare the importance attributed to different end-of-life needs by terminally ill older adult patients in long-term care facilities, their families and care providers (physicians and nurses).

METHOD

This descriptive, cross-sectional study recruited a convenience sample of 451 subjects, including 73 terminally ill older adult patients, 58 family members, 71 physicians and 249 nurses, from two Israeli geriatric centers.

RESULTS

This study found a high congruence between the staff and terminally ill older adults and their families regarding most needs identified as important to dying people. The five needs identified as most important by all subjects were: not suffering pain, having no difficulty breathing, maintaining dignity, having someone who listens, and receiving adequate nursing care. The results of this survey suggest that for terminally ill older adult patients and their families, physical care is crucial. In contrast, nurses attribute higher significance to spiritual needs, but this finding may be affected by the fact that the rate of religiosity among nurses was much higher than among all other research groups.

CONCLUSIONS

Identifying terminally ill older adults' end-of-life needs may enable nurses and physicians to modify and improve end-of-life care. This could result in a substantial decrease in suffering amongst nursing home terminally ill older adult patients and their families.