Journal
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
Volume 48, Issue 5, Pages 839-851Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jpainsymman.2013.12.240
Keywords
Quality of dying and death; good death; palliative care; place of death; cancer; bereavement; caregivers
Funding
- Canadian Institutes of Health Research [74684]
- National Cancer Institute of Canada
- Ontario Cancer Institute at The Princess Margaret Cancer Centre, University Health Network
- Ontario Ministry of Health and Long-Term Care (OMOHLTC)
- University of Toronto/University Health Network Harold and Shirley Lederman Chair in Psychosocial Oncology and Palliative Care
- Princess Margaret Cancer Foundation Hertz Centre Fund
- Campbell Family Cancer Research Institute
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Context. Health care is increasingly focused on end-of-life care outcomes, but relatively little attention has been paid to how the dying experience is subjectively evaluated by those involved in the process. Objectives. To assess the quality of death of patients with cancer and examine its relationship to receipt of specialized palliative care and place of death. Methods. A total of 402 deaths of cancer patients treated at a university-affiliated hospital and home palliative care program in downtown Toronto, Ontario, Canada were evaluated by bereaved caregivers eight to 10 months after patient death with the Quality of Dying and Death (QODD) questionnaire. Caregivers also reported on bereavement distress, palliative care services received, and place of death. Results. Overall quality of death was rated good'' to almost perfect'' by 39% and neither good nor bad'' by 61% of caregivers. The lowest QODD subscale scores assessed symptom control (rated terrible'' to poor'' by 15% of caregivers) and transcendence over death-related concerns (rated terrible'' to poor'' by 19% of caregivers). Multivariable analyses revealed that late or no specialized palliative care was associated with worse death preparation, and home deaths were associated with better symptom control, death preparation, and overall quality of death. Conclusion. The overall quality of death was rated positively for the majority of these cancer patients. Ratings were highest for home deaths perhaps because they are associated with fewer complications and/or a more extensive support network. For a substantial minority, symptom control and death-related distress at the end of life were problematic, highlighting areas for intervention. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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