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Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer

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ABSTRACT

Purpose

Knowing how to improve the dying experience for patients with end-stage cancer is essential for cancer professionals. However, there is little evidence on the relationship between clinically relevant factors and quality of death. Also, while hospice has been linked with improved outcomes, our understanding of factors that contribute to a “good death” when hospice is involved remains limited. This study (1) identified correlates of a good death and (2) provided evidence on the impact of hospice on quality of death.

Methods

Using data from a survey of US households affected by cancer (N = 930, response rate 51 %), we fit regression models with a subsample of 158 respondents who had experienced the death of a family member with cancer. Measures included quality of death (good/bad) and clinically relevant factors including: hospice involvement, symptoms during treatment, whether wishes were followed, provider knowledge/expertise, and compassion.

Results

Respondents were 60 % female, 89 % White, and averaged 57 years old. Decedents were most often a respondent’s spouse (46 %). While 73 % of respondents reported a good death, Hispanics were less likely to experience good death (p = 0.007). Clinically relevant factors, including hospice, were associated with good death (p < 0.05)—an exception being whether the physician said the cancer was curable/fatal. With adjustments, perceptions of provider knowledge/expertise was the only clinical factor that remained associated with good death.

Conclusions

Enhanced provider training/communication, referrals to hospice and greater attention to symptom management may facilitate improved quality of dying. Additionally, the cultural relevance of the concept of a “good death” warrants further research.

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Acknowledgments

Dr. Cagle’s efforts were supported by grants from NIA 2T32AG000272 and the National Palliative Care Research Center. The authors thank the Kaiser Family Foundation, USA Today, and the Harvard School of Public Health for their sponsorship of the original study and the Roper Center for use of their data.

Conflict of interest

The authors do not have any financial disclosures to report. Primary data for the findings reported here are available through the Roper Center.

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Authors and Affiliations

  1. School of Social Work, University of Maryland, 525West Redwood Street, 3W13, Baltimore, MD, 21201, USA

    John G. Cagle

  2. York University, Toronto, Canada

    Jolynn Pek

  3. Florida State University, Panama City, USA

    Maggie Clifford

  4. University of Maryland, Baltimore, USA

    Jack Guralnik

  5. University of North Carolina at Chapel Hill, Chapel Hill, USA

    Sheryl Zimmerman

Authors
  1. John G. Cagle
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  2. Jolynn Pek
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  3. Maggie Clifford
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  4. Jack Guralnik
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  5. Sheryl Zimmerman
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Correspondence to John G. Cagle.

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Cagle, J.G., Pek, J., Clifford, M. et al. Correlates of a good death and the impact of hospice involvement: findings from the national survey of households affected by cancer. Support Care Cancer 23, 809–818 (2015). https://doi.org/10.1007/s00520-014-2404-z

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  • DOI: https://doi.org/10.1007/s00520-014-2404-z

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