PhotoYou might not like to think about it but one thing all consumers will be buying one of these days is "death services" -- the euphemism of the funeral industry. 

And just before that, we may be in the market for "dying services" -- which can range from having an intern pound on our chest in an emergency room to drifting peacefully away under hospice care.

You may say that while dying is often unpleasant, we only have to do it once, so it's not so bad. But that argument also works the other way -- since we only do it once, we're often not very good at it. Let's face it -- unless an air conditioner falls on us while we're walking down the street, the pathway to our exit may be a lengthy and painful one.

But if we lived in Canada, it might be a lot better, a recent study finds. Researchers from the Princess Margaret Cancer Centre in Toronto said they found that the overall quality of death of cancer patients who die in an urban Canadian setting with ready access to palliative care was good to excellent in the large majority of cases, helping to dispel the myth that marked suffering at the end of life is inevitable.

"Fear of dying is something almost every patient with advanced cancer or other life-threatening illness faces, and helping them, to achieve a 'good death' is an important goal of palliative care," said the center's Dr. Sarah Hales.

"We know a lot about disease and the physical symptoms that it may produce, but only recently have we focused on approaches to relieve the fear of death in patients and families and to address the emotional, spiritual and existential concerns that support the quality of the dying experience," she said.

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402 deaths studied

Thirty-nine percent (39%) of the sample scored in the "good' to "almost perfect" range of a scale measuring the dying experience, with 61% of the sample scoring in the "neither good nor bad" range of the scale.

Better scores were linked to older patients, high social support (most patients were not living alone), older caregiver age, English as the primary language of the caregiver, greater length of relationship between the caregiver and patient, less caregiver bereavement distress (i.e. grief, stress-response, and depressive symptoms) and home death.

The study examined 402 deaths of cancer patients between 2005 and 2010 in the three acute care hospitals of University Health Network and from the Tammy Latner Centre for Palliative Care, a home palliative care program at Mount Sinai Hospital in Toronto.

Caregivers of the patients who spoke and read English were contacted and, those who agreed, were interviewed about the quality of death and dying using the Quality of Dying and Death (QODD) questionnaire, the most widely used and best validated tool to assess the dying experience.

Although the dying and death experience ratings were generally positive, for a substantial minority, symptom control and death-related distress at the end of life were problematic. Fifteen per cent (15%) of the sample scored in the "terrible" to "poor" range for symptom control, with 19 percent scoring in the same range for Transcendence – feeling unafraid of or making peace with dying. These could be areas in which further interventions are needed to improve outcomes, say the authors.

The study is being published in the Journal of Pain and Symptom Management.

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