What makes a “good” death?

People want control over their lives, and that feeling doesn’t stop… even when they are nearing the end.

That’s one takeaway from a study, published in the American Journal of Geriatric Psychiatry, that delved into the controversial topic of what defines a “good death.”

Researchers reviewed 36 international studies in which patients, their families and health care providers offered their views on end-of-life and what was most important. Throughout the research, 11 core themes of “successful dying” emerged, including pain-free treatment, emotional well-being, dignity, quality of life and relationship with their hospital. More than half of patients interviewed were at least 60 years old.

“The take-home, to me, is that we really need to talk to patients about the dying process,” said Dr. Dilip Jeste, senior researcher on the study, in a news release. “Even if patients want to talk about it, they may be afraid to bring it up with their families because they don’t want to upset them.”

With dying process (94 percent), pain-free status (81 percent) and emotional well-being (64 percent) polling as the top three concerns, many medical experts believe it’s necessary to have the tough talk, as challenging as it may be.

“Death is not an easy topic because a lot of family members don’t want to confront the difficult issue,” says Dr. Harley Brooks, medical director of care management and a physician advisor at Advocate Trinity Hospital in Chicago. “But it can’t be a conversation that we shy away from as family members.”

Researchers recommend that having a good dialogue before a family member falls ill can help ensure the best dying process. Sometimes there can be a disconnect, with doctors often more focused on pain control and patients’ preferences for how and where they die, and less focused on the existential – a sense of life completion and spirituality – which may be important to patients.

“It’s really essential that families start the process of talking about their end-of-life plans, which can include if they want their lives prolonged by a ventilator or if they want other measures,” says Dr. Brooks. “It’s extremely tough to have those conversations for the first time when everything is happening at a hospital.”