Care of the Dying Patient

In contrast to the numerous maladies described elsewhere in this textbook, successful care of the dying patient is not measured in terms of convalescence but rather in achievement of a “good death.” While the circumstances of death among the seriously ill in US hospitals are well defined - a high prevalence of pain and frequency of invasive procedures - the characteristics of a “good death” vary between patient, family, and provider (A controlled trial to improve care for seriously ill hospitalized patients, JAMA 274:1591-8, 1995; Hales et al., Palliat Med 24(2):127-44, 2010). Frequently cited characteristics of a “good death” include control of severe pain, reduction of stress and anxiety, provider compassion, and the perceived knowledge and expertise of the physician (Cagle JG, et al., Support Care Cancer 23(3):809-18, 2014). However, patients with terminal conditions often report a sense of abandonment by their primary provider (Back et al., Arch Intern Med 169(5):474-9, 2009). Increased end-of-life education among family physicians is critical in shifting patient deaths out of the hospital and into the comforts of home in effort to improve end-of-life care (Reyniers et al., Ann Fam Med 12:441, 2014).