Critical Events in the Dying Process: The Potential for Physical and Psychosocial Suffering

BACKGROUND: Understanding what aspects of the dying process motivate terminally ill individuals to consider hastening their death, can lead to improving end-of-life care. OBJECTIVE: Advance knowledge regarding critical events within the dying process that have the potential to give rise to physical and psychosocial suffering such that an elder wishes for or considers a hastened death. DESIGN AND METHODS: Face-to-face in-depth qualitative interviews conducted with 96 terminally ill elders, 15 of whom discussed an event in their dying process that resulted in suffering so great they wished for, or considered, a hastened death. Data were content analyzed to identify and categorize the main themes and patterns involved in these elders' experiences. SETTING: The interviews were conducted on palliative care hospital units, and in outpatient clinics, free standing hospice facilities, and home hospice. RESULTS: Four critical events emerged: perceived insensitive and uncaring communication of a terminal diagnosis; experiencing unbearable physical pain; unacknowledged feelings regarding undergoing chemotherapy or radiation treatment; and dying in a distressing environment. Respondents discussed physical and/or psychosocial suffering that occurred at these events, and the end-of-life care practices that reduced their suffering. CONCLUSION: Awareness of events common to the dying process, the potential physical and psychosocial suffering that may arise at these events, and the end-of-life care practices associated with reducing that suffering can lead to health care professionals being able to take a proactive rather than reactive approach to end-of-life care.