Supportive Care in Cancer

, Volume 23, Issue 3, pp 809–818 | Cite as

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

  • John G. CagleEmail author
  • Jolynn Pek
  • Maggie Clifford
  • Jack Guralnik
  • Sheryl Zimmerman
Original Article



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.


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.


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.


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.


Provider communication Quality of death Hospice Palliative care End of life Good death 



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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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • John G. Cagle
    • 1
    Email author
  • Jolynn Pek
    • 2
  • Maggie Clifford
    • 3
  • Jack Guralnik
    • 4
  • Sheryl Zimmerman
    • 5
  1. 1.School of Social Work, University of MarylandBaltimoreUSA
  2. 2.York UniversityTorontoCanada
  3. 3.Florida State UniversityPanama CityUSA
  4. 4.University of MarylandBaltimoreUSA
  5. 5.University of North Carolina at Chapel HillChapel HillUSA

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