In Search of a Good Death: Observations of Patients, Families, and Providers

@article{Steinhauser2000InSO,
  title={In Search of a Good Death: Observations of Patients, Families, and Providers},
  author={Karen E. Steinhauser and Elizabeth C. Clipp and Maya McNeilly and Nicholas A. Christakis and Lauren M. McIntyre and James A. Tulsky},
  journal={Annals of Internal Medicine},
  year={2000},
  volume={132},
  pages={825-832}
}
Professional organizations and the public have recently made care of the dying a national priority (1-7). Despite this, however, we remain confused about what constitutes a good death (8). Some patients with terminal illnesses choose to leave the conventional medical setting and receive hospice care in their home, surrounded by family. Others seek experimental chemotherapy in an intensive care unit. In each of these vastly different scenarios, the perception of the quality of death is… 

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References

SHOWING 1-10 OF 47 REFERENCES

Care at the End of Life: Guiding Practice Where There Are No Easy Answers

There is a sharp transition from disease-oriented therapy to palliative care and control of symptoms, relief of distress, promoting quality of life, and attending to the psychosocial aspects of illness are appropriate in all stages of disease.

Intensive care, old age, and the problem of death in America.

The relationship of elderly deaths in the intensive care unit to the cultural conversation about the desire for "death with dignity" is explored as part of a larger anthropological investigation of how death occurs in the hospital.

Patients' perspectives on dying and on the care of dying patients.

Patients experience a reduction in both physical and psychological aspects of suffering when physicians use good communication skills, are sensitive to patients' perspectives, and actively work to reduce barriers to mutual understanding.

Good Care of the Dying Patient

This review is the third in a series of reports on physician-assisted suicide requested by the American Medical Association Board of Trustees in response to Resolution 3 at the 1993 House of Delegates Annual Meeting.

Death Foretold: Prophecy and Prognosis in Medical Care

It is argued that physicians and the medical profession as a whole have the duty to prognosticate, and shirking the difficult questions - as most doctors tend to do - advances neither medical knowledge nor the care seriously ill patients receive.

Quality end-of-life care: patients' perspectives.

These domains, which characterize patients' perspectives on end-of-life care, can serve as focal points for improving the quality of end- of- life care.

Discussing Palliative Care with Patients

The same simple techniques that physicians are trained to use in everyday clinical encounters can facilitate discussions in palliative care, including exploring the patient's perception of illness and prognosis by using open-ended questions and by asking follow-up questions that incorporate the patient’s own words.

A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators.

The phase I observation of SUPPORT confirmed substantial shortcomings in care for seriously ill hospitalized adults and the phase II intervention failed to improve care or patient outcomes.

Advance directives for medical care--a case for greater use.

Advance directives as part of a comprehensive approach such as that provided by the Medical Directive are desired by most people, require physician initiative, and can be achieved during a regular office visit.

Patients with cancer and their spouse caregivers. Perceptions of the illness experience

It was concluded that caregivers can serve as proxies for patients with cancer in research and clinical settings when objective data are sought, and that patients viewed marital quality more negatively than did caregivers.