Vig Elizabeth K, Pearlman Robert A
Department of Medicine and Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, USA.
Arch Intern Med. 2004 May 10;164(9):977-81. doi: 10.1001/archinte.164.9.977.
Understanding the range of patients' views about good and bad deaths may be useful to clinicians caring for terminally ill patients. Our current understanding of good and bad deaths, however, comes primarily from input from families and clinicians. This study aimed to learn how terminally ill men conceptualize good and bad deaths.
We conducted semistructured interviews with 26 men identified as having terminal heart disease or cancer. Participants described good and bad deaths in a section of open-ended questions. Participants also answered closed-ended questions about specific end-of-life scenarios. The open-ended questions were tape recorded, transcribed, and analyzed using grounded theory methods. The closed-ended questions were analyzed using descriptive statistics.
We found heterogeneity in responses to questions about good deaths, bad deaths, and preferred dying experiences. Participants voiced multiple reasons for why dying in one's sleep led to a good death and why prolonged dying or suffering led to a bad death. Participants did not hold uniform views about the presence of others at the very end of life or preferred location of dying.
In discussing the end of life with terminally ill patients, clinicians may want to identify not only their patients' views of good and bad deaths but also how the identified attributes contribute to a good or bad death. The discussion can then focus on what might interfere with patients' attainment of their preferred dying experience and what may be available to help them achieve a death that is most consistent with their wishes.
了解患者对于善终和恶终的看法范围，可能对照顾绝症患者的临床医生有所帮助。然而，我们目前对于善终和恶终的理解，主要来自于家属和临床医生的看法。本研究旨在了解绝症男性如何界定善终和恶终。
我们对26名被确诊患有晚期心脏病或癌症的男性进行了半结构化访谈。参与者在一组开放式问题中描述了善终和恶终的情况。参与者还回答了关于特定临终场景的封闭式问题。开放式问题进行了录音、转录，并采用扎根理论方法进行分析。封闭式问题采用描述性统计方法进行分析。
我们发现，对于善终、恶终和理想死亡体验的问题，参与者的回答存在异质性。参与者阐述了为何在睡眠中离世会带来善终，以及为何长期垂死或遭受痛苦会导致恶终的多种原因。对于生命末期他人的在场情况或理想的死亡地点，参与者并未持有统一的看法。
在与绝症患者讨论生命末期问题时，临床医生不仅要了解患者对于善终和恶终的看法，还要了解所确定的属性如何促成善终或恶终。然后，讨论可以聚焦于哪些因素可能会干扰患者获得理想的死亡体验，以及有哪些资源可以帮助他们实现与自己愿望最相符的死亡。
