Evaluating the “Good Death” Concept from Iranian Bereaved Family

O R I G I N A L R E S E A R C H
Evaluating the “Good Death” Concept
from Iranian Bereaved Family Members’
Perspective
Sedigheh Iranmanesh, PhD, Habibollah Hosseini, doctoral student, and
Mohammad Esmaili, MSc student
Alife-threatening disease such as cancer involves
patients and their families. Even if
people today prefer to die at home and to
be cared for by their family members, they still
need professional services and support. 1 Improving
the quality of death has become a major need
for patients, their families and loved ones, as well
as health-care professionals, researchers, and policy
makers who organize and provide care. 2 Since
the 1960s, our approach to this need has been
palliative care. The philosophy of end-of-life care
is to alleviate suffering and to improve the quality
of life of patients who are facing death. Despite
a recent increase in the attention given to
improving end-of-life care, our understanding of
what constitutes a good death is surprisingly
lacking. The Longman Dictionary of Contemporary
English 3 defines good death as “the calm end of life
of a person without any worry or excitement.”
Family members who face the death of their
loved ones are key to evaluating the good death
concept. Their views on death could be used by
the health-care system to evaluate the quality of
end-of-life care. Therefore, the concept of a
“good death” as perceived by the general Iranian
population could be sought by studying the views
of a representative sample of bereaved family
members. Health-care providers, who are aware
of what constitutes a good death, have an openness
and flexibility when working with dying
From the Razi Faculty of Nursing and Midwifery, Kerman
Medical University, Kerman, Iran.
Manuscript Submitted August 4, 2010; Accepted December
1, 2010.
Correspondence to: Habibollah Hosseini, Razi Faculty of
Nursing and Midwifery, Kerman Medical University, Kerman,
Iran; Phone: 00983413205220; Fax: 00983413205218;
e-mail: seha.hosseini@gmail.com
J Support Oncol 2011;9:59–63 © 2011 Published by Elsevier Inc.
doi:10.1016/j.suponc.2010.12.003
Abstract Improving end-of-life care demands that first you define
what constitutes a good death for different cultures. This study was
conducted to evaluate a good death concept from the Iranian bereaved
family members’ perspective. A descriptive, cross-sectional study was
designed using a Good Death Inventory (GDI) questionnaire to evaluate
150 bereaved family members. Data were analyzed by SPSS. Based on
the results, the highest scores belonged to the domains “being respected
as an individual,” “natural death,” “religious and spiritual comfort,”
and “control over the future.” The domain perceived by family
members as less important was “unawareness of death.” Providing a
good death requires professional caregivers to be sensitive and pay
attention to the preferences of each unique person’s perceptions. In
order to implement holistic care, caregivers must be aware of patients’
spiritual needs. Establishing a specific unit in a hospital and individually
treating each patient as a valued family member could be the best way
to improve the quality of end-of-life care that is missing in Iran.
patients to improve quality of care as well as the
patient’s quality of life.
From a review of different studies, the core
quality of a good death varies among cultures. In
a qualitative study, Griggs 4 analyzed perceptions
of a “good death” among community nurses in
England. Nurses identified several key themes for
a good death, such as: symptom control, patient
choice, honesty, spirituality, interprofessional relationships,
effective preparation, organization,
and provision of seamless care. American researchers
concluded that a good death involves
respect for the individual’s autonomy with open
communication among family members. 5 Vig
and Pearlman 6 also reported that “good death”
has an individual meaning for Americans and
does not have a consensual meaning. In Ghana,
Van der Greest 7 found that a good death is integrated
with a peaceful death, meaning peace
with others, being at peace with one’s own life
and soul, dying in the fullness of time, dying at
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