FACTORSASSOCI

ATEDWI
THGOODDEATH

by
GemmaN.Bal
ein,D.M.
D.,
M.A.
,M.
S.

Abst
ract

Sev eralst udi es abr oad hav e alreadyexpl ored t he f actors consi dered
i
mpor tantatend ofl ife among t ermi nal ly-i
llpat ient s,f ami lymember s and
healthcar e pr ov i
der s. Resul ts gather ed r anged f rom “ freedom f rom pai n”,
"autonomy ,cont roland i ndependence" ,“ accept ance,cl osur e mostof ten at
home” ,t o“ medi calcar e,sensi ti
v i
tyt or eligiousandspi rit
ualv alues,l iv
ingwel l
withGod. ”
Thisst udyf ocusesonf actorsassoci atedwi t
hgooddeat hasper ceiv edby
terminal l
y-il
lpat ient s,f ami lymember sandheal t
hcar epr ov i
der s.Speci fi
cal l
y,it
aimst oknowwhatf act orsatendofl ifewi l
lber atedasext remel yi mpor tantby
mor et han70% oft hesur veypar ticipant sandt ofindoutwhi chf actor swi l
lbe
selectedandr ankedasf i
vemosti mpor t
antatendofl if
e.St ruct ur
edf acet of ace
i
nter vi
ews,usi ngamodi fi
ed35- item quest ionnai r
e,wer econduct edamong35
patients,41 f ami lymember sand 34 heal thcarepr ovider satt heSuppor ti
v e
Palli
ativeandHospi ceCar eCl i
nicandt heCancerI nst itute,Uni versityoft he
Phili
ppi nes-Phi lippi neGener alHospi tal.
Descr i
pt ivest at i
st i
csandwei ghtedmeanwer eusedt odet ermi net he
percept ionsr egar dingf act orsassoci atedwi thgooddeat h. One- wayANOVA
and Mul t
ipleCompar isonsschef fetest s,wer eusedt oexami net hesi gnificance
ofspeci f
icr esponsedi fferencesamonggr oups.
Amaj orf indi ngoft hi sstudyi st hest rongagr eementamongend- of-l
ife
carepar ti
cipant s' def initionsofwhatconst itut esagooddeat h.Oneoft hesur vey
i
tems showed consensus among al l 3 gr oups. Sur vey par t
icipant s
overwhel mingl yr anked“ Comet opeacewi thGod”ast he1stmosti mpor t
ant.
Regar dlessofr ole, respondent sconv ergedont heimpor tanceofspi ritualsuppor t
attheendofl ife.
Thef indi ngsoft hisst udywer eusedasaspr ingboar dtoaugmentt he
under standi ngofgooddeat h.Acr ucialpar toft hedi scussi oni st her ev i
sitingof
the literaturer ev iew i nl i
ghtoft he r esear ch f i
ndi ngs and concl udes wi th
i
mpl icat i
onsandpot ent i
ali mpact st hisr esear chpr ojecthasi nt hef ieldsof
medi cine, bioet hics, andsoci etyatl arge.
 FACTORSASSOCI
ATEDWI THGOODDEATH
by
GemmaN.Bal
ein,D.M.
D.,
M.A.
,M.
S.

I
NTRODUCTI
ON

Deat
hisaphenomenont
hatev
ery
one,wi
thoutexcept
ion,wi
l
lul
ti
mat
ely

hav
etoconf
rontasar
eal
i
ty.Whet
herdi
seasedornot
,thecel
l
sandt
hehuman

bodyhav
eal
i
mit
edl
i
fespan.Thi
sisat
rut
hver
ymuchr
elat
edt
oincur
abl
eand

t
ermi
nali
l
lness,y
et,asBenedi
ctt
heXVIput
sit
,“cont
empor
arycul
tur
etendst
o

hi
dedeat
hbecausei
tseemst
ofeardeat
h;andsi
ncei
tcannotov
ercomei
t

despi
tet
hepr
ogr
essofmedi
cine,
itpr
efer
snott
othi
nkabouti
tandhi
dei
taway
”

(
Bar
agan,2007)
.Whendeat
handdy
ingar
eper
cei
vedasapr
obl
em,suf
fer
ing

becomesdev
oidofmeani
ngandev
ery
thi
ngmustbedonet
oel
i
minat
eit
;and

whent
hisi
snotachi
eved,r
ecour
set
oeut
hanasi
aismade;anactsomet
imes

donei
nthenameofaut
onomy
,benef
icenceandnon-
mal
efi
cence.

Somer
esponsest
othepai
nandsuf
fer
ingexper
iencedbydy
ingpat
ient
s

hav
ebeent
hei
mpl
ement
ati
onofsoci
alpol
i
ciest
hatcanhel
pel
i
minat
ethe

causesofmanydi
seasesandt
hei
mpr
ovedcar
efort
hedy
ingandf
orwhom no

medi
cal
remedyi
sav
ail
abl
e.

Asdy
ingi
snoteasy
,“goodorhappydeat
h”or“
dyi
ngwel
l
”hasbeena

commongoal
forpat
ient
s,f
ami
l
ymember
s,andheal
thcar
epr
ovi
der
s.I
nanef
for
t

t
opr
omot
egooddeat
h,ev
ent
hef
iel
dofBi
oet
hicshasbeencent
eri
ngi
tsdeat
h

and dy
ing di
scussi
ons on adv
ance di
rect
ives,l
i
ving wi
l
ls,ext
raor
dinar
yand

or
dinar
ycar
e,eut
hanasi
a,et
c.Butwhatdoes“
gooddeat
h”or“
dyi
ngwel
l
”real
l
y

mean?
 Sev
eralst
udi
es abr
oad hav
e al
readyexpl
ored t
he f
act
ors consi
der
ed

i
mpor
tantatend ofl
i
fe among t
ermi
nal
l
y-i
l
lpat
ient
s,f
ami
l
ymember
s and

heal
thcar
e pr
ovi
der
s. Resul
ts gat
her
ed r
anged f
r f
om “reedom f
rom pai
n”

(
Chr
ist
aki
s, ,"accept
2005) anceandcl
osur
e,mostof
tenathome"(
Stei
nhauser
,

2000)
,“aut
onomy
,cont
rolandi
ndependence”(
TheFut
ureofHeal
thandCar
eof

Ol
derPeopl
e,1999)t
o“pr
opermedi
calcar
e,sensi
ti
vi
tyt
other
eli
giousand

spi
ri
tualv
alues,andl
i
vingwel
lwi
thGod”(
Sheenan,2000)
. Howev
er,t
hepr
e-

emi
nencet
hatWest
erncul
tur
epl
acesont
hepr
inci
pleofaut
onomyatendofl
i
fe

hasof
tenbeenchal
l
engedbyt
hepr
act
ices,bel
i
efsandv
aluesoft
heFi
l
ipi
nos.

Bi
oet
hics,t
her
efor
e,needst
oaddr
ess,under
standandpr
act
icei
tsdi
sci
pli
nei
n

t
hePhi
l
ippi
nesaccor
dingt
othecount
ry’
snor
msandcul
tur
e

Fol
l
owi
ngt
hest
udi
esment
ionedabov
e,t
hisst
udyf
ocusedonf
act
ors

associ
ated wi
th good deat
h as per
cei
ved by t
ermi
nal
l
y-i
l
lpat
ient
s,f
ami
l
y

member
sandheal
thcar
epr
ovi
der
s att
heSuppor
ti
vePal
l
iat
iveCl
i
nicandt
he

CancerI
nst
it
uteUni
ver
sit
yoft
hePhi
l
ippi
nes-
Phi
l
ippi
neGener
alHospi
tal
.

A maj
ori
mpactt
hisr
esear
chcoul
d hav
eisi
nthef
iel
d ofbi
oet
hics.

Fi
ndi
ngsi
nthi
sst
udycanpr
ovi
dei
mpor
tantcl
uesonwhatdeat
handdy
ing

i
ssues Bi
oet
hics needs t
o addr
ess i
nthe Phi
l
ippi
ne cont
ext
.Bi
oet
hical

di
scussi
onscent
eri
ngont
hoseext
remel
yimpor
tantf
act
orsatendofl
i
fecan

hel
pcar
einst
it
uti
onsandet
hicsr
evi
ew boar
dspr
ovi
debet
terendofl
i
fecar
e,

t
hus,
prov
idi
ngahumane,
digni
fi
edandgooddeat
h.
St
atementoft
hePr
obl
em

Speci
fi
cal
l
y,t
hest
udyai
medt
oanswert
hef
oll
owi
ngquest
ions:

1.Toi
dent
if
ywhi
choft
hef
act
orsassoci
atedwi
thgooddeat
hwer
erat
ed

asext
remel
yimpor
tantby70%of:

1a.pat
ient
s

1b.f
ami
l
ymember
s

1c.heal
thcar
epr
ovi
der
s

2.Tof
indoutwhi
chf
act
orsassoci
atedwi
thgooddeat
hwer
esel
ect
ed

andr
ankedas5mosti
mpor
tantatendofl
i
fe.

3.Todet
ermi
nei
fther
eisasi
gni
fi
cantdi
ff
erencei
ntheper
cept
ionsof

t
ermi
nal
l
y-i
l
lpat
ient
s,f
ami
l
ymember
s and heal
thcar
e pr
ovi
der
sin

t
ermsoft
hef
act
orssel
ect
edandr
ankedasmosti
mpor
tantatendof

l
i
fe.

Thenul
lhy
pot
hesi
srai
sedi
nthi
sst
udyt
obeaccept
edorr
eject
edat.
05

l
evel
ofsi
gni
fi
cancewas:

Ther
eisnosi
gni
fi
cantdi
ff
erencei
ntheper
cept
ionsoff
act
orsassoci
ated

wi
thgooddeat
hamongt
ermi
nal
l
y-i
l
lpat
ient
s,f
ami
l
ymember
sandphy
sici
ans.

Met
hodol
ogy

Fr
om June-
August2007,st
ruct
ured f
acet
ofacei
nter
views,usi
ng a

modi
fi
ed35-
it
em quest
ionnai
re,wer
econduct
edamong35pat
ient
s,41f
ami
l
y

member
sand34heal
thcar
epr
ovi
der
satt
heSuppor
ti
vePal
l
iat
iveCl
i
nicandt
he

CancerI
nst
it
uteUni
ver
sit
yoft
hePhi
l
ippi
nes-Phi
l
ippi
neGener
alHospi
tal
.
 Toensur
eav
ali
dandr
eli
abl
eanal
ysi
sandi
nter
pret
ati
onofdat
a,t
he

f
oll
owi
ngst
ati
sti
cal
treat
ment
swer
eusedbyt
her
esear
cher
:

he 1st speci
To answert fi
cobj
ect
ive,descr
ipt
ive st
ati
sti
cswer
e used

speci
fi
cal
l
yfr
equencycountandper
cent
agesi
ntabul
ati
onoft
her
espondent
s’

answert
othe quest
ionnai
re. Thi
s was t
o descr
ibe t
he r
esponses as t
o

demogr
aphi
csandwhatf
act
orst
heyconsi
derext
remel
yimpor
tantatendofl
i
fe.

he2nd speci
Fort fi
cobj
ect
ive,t
hemeanr
ankscor
ewer
eassessedf
ort
he5

r
anked i
t he 3rd speci
ems. Fort fi
cobj
ect
ive,one-
wayANOVA and Mul
ti
ple

Compar
isonschef
fet
est
sat.
05l
evelofsi
gni
fi
cancewer
eusedt
ocompar
e

r
esponsesbet
weengr
oups.Schef
fet
estper
for
mssi
mul
taneousj
ointpai
rwi
se

compar
isonsf
oral
lpossi
blepai
rsofmeans.Al
ldat
awer
eent
eredt
hroughEpi

I
nfosof
twar
ever
sion6andSt
ata10setat0.
05l
evel
ofsi
gni
fi
cance.

Oncet
hef
indi
ngswer
eanal
yzedanddev
eloped,t
heywer
eusedasa

spr
ingboar
dtoaugmentt
heunder
standi
ngofgooddeat
h.Ascr
uci
alpar
toft
he

di
scussi
on, t
hispaperal
sor
evi
sit
sthel
i
ter
atur
erev
iewi
nli
ghtoft
her
esear
ch

f
indi
ngsandconcl
udeswi
thi
mpl
i
cat
ionsandpot
ent
iali
mpact
sthi
sresear
ch

pr
ojecthasi
nthef
iel
dsofmedi
cine,
bioet
hics,
andsoci
etyatl
arge.

Fi
ndi
ngsandConcl
usi
on

I
nter
msofr
ati
ngsofat
tri
but
eimpor
tance(
Appendi
xA,BandC)
,,an

i
nter
est
ingf
indi
ngi
nthi
sst
udyi
show “
comet
opeacewi
thGod”r
ankedf
ir
st

amongpat
ient
sandf
ami
l
ymember
sregar
dlessofwhet
herornoti
twasr
atedas

ext
remel
yimpor
tantbymor
ethan70% oft
her
espondent
s.I
not
heraspect
s,
t
her
ewasabr
oadr
esponseamongt
he3gr
oupsast
owhi
chf
act
orswer
erat
ed

asext
remel
yimpor
tantatendofl
i
fe.Resul
tsshow t
hatf
orpat
ient
s“comet
o

peacewi
thGod”i
sext
remel
yimpor
tant
.Wher
easheal
thcar
epr
ovi
der
stendt
o

cent
eronphy
sical
,soci
al,
andemot
ional
aspect
sasext
remel
yimpor
tantf
ort
he

dy
ing,f
ami
l
ymember
stendednott
ovi
ew pat
ient
s’andheal
thcar
epr
ovi
der
s’

choi
ces wi
tht
hesamei
mpor
tance.Consi
stentwi
thpr
evi
ousr
esear
ch(
Tul
sky
,

2000)
,dependi
ngont
her
olet
heypl
ayed,phy
sici
ans’di
scussi
onswer
emedi
cal

i
nnat
urewhi
l
e soci
alwor
ker
swer
emor
eat
tunedt
otheneedsoft
hef
ami
l
yas

uni
tofcar
e;pr
ofessi
onal
rol
essubst
ant
ial
l
yshapedt
hev
iewsoft
hedi
scussant
s.

Pr
obabl
yper
cei
vi
ngl
ackofconf
idencei
npr
ovi
dingspi
ri
tualsuppor
t,“
comet
o

peacewi
thGod”amongheal
thcar
epr
ovi
der
sdi
dnotr
eacht
he70%mar
kint
his

st
udy
.Inanot
herr
esear
ch,
forexampl
e,t
hef
oll
owi
ngf
act
orswer
econsi
stent
ly

r
atedasi
mpor
tantbymor
ethan70%oft
hepat
ient
sbutwer
esi
gni
fi
cant
lyl
ess

i
mpor
tantbyphy
sici
ans:bei
ng ment
all
yawar
e,hav
ing f
uner
alar
rangement
s

pl
anned,f
eel
i
ngt
hatone'
sli
fewascompl
ete,notbei
ngabur
dent
ofami
l
yor

soci
ety
,bei
ngabl
etohel
pot
her
s,comi
ngt
opeacewi
thGod,andpr
ayi
ng.I
n

anot
herst
udy(
Teno,1996)
,resul
tsshowedt
hatmaj
ori
tyoff
ami
l
ymember
s

bel
i
eved t
hatpat
ient
spr
efer
red comf
ort
,butl
i
fe-
sust
aini
ng t
reat
ment
swer
e

of
tenused.Whi
l
emostpat
ient
srepor
tedl
ypr
efer
redanappr
oacht
ocar
ethat

f
ocused on comf
ort
,ev
en i
fthi
s appr
oach shor
tened l
i
fe,f
ami
l
ymember
s

r
epor
tedt
hatact
ualcar
ewasatoddswi
thpat
ientpr
efer
encesi
nabout1i
n10

cases.Thi
sser
vesasar
emi
ndert
hatgooddeat
hishi
ghl
yindi
vi
dual
i
zed;
qual
i
ty

end-
of-
li
fecar
eisanact
ivepr
ocesst
hati
snegot
iat
edagai
nandagai
namong
pat
ient
s,f
ami
l
ies,
andheal
thcar
epr
ofessi
onal
s,apr
ocessbasedoni
ndi
vi
dual

v
aluesandknowl
edge.

Howev
er,af
terhav
ing been asked t
o sel
ectand r
ank t
he f
ive most

i
mpor
tantf
act
orsatendofl
i
fef
rom t
hegi
ven35at
tr
ibut
es,
resul
ts(
Appendi
xD)

r
evealan ar
ea of st
rong agr
eementamong end-
of-
li
fe car
e par
ti
cipant
s'

def
ini
ti
onsofwhatconst
it
utesagooddeat
h.Onl
yoneoft
hesur
veyi
tems

showed consensusamong al
l3 gr
oups.Sur
veypar
ti
cipant
sov
erwhel
mingl
y

r
anked“
Comet
opeacewi
t he1stmosti
hGod”ast mpor
tant
.Regar
dlessofr
ole,

r
espondent
sconv
ergedont
hei
mpor
tanceofspi
ri
tualsuppor
tatt
heendofl
i
fe.

I
tcanbesai
d,t
her
efor
e,t
hatnotonl
ydy
ingpat
ient
shav
ethei
rspi
ri
tualand

r
eli
gious concer
ns awakened ori
ntensi
fi
ed,butal
so f
ami
l
y member
s and

heal
thcar
e pr
ovi
der
s who ar
e di
rect
lyi
nvol
ved wi
th per
sons neardeat
h.

Per
cept
ionsof“
comet
opeacewi
thGod”mayv
aryamongpar
ti
cipant
soft
he

st
udybutsomemayhav
ebeenl
edt
ochoose“
comet
opeacewi
thGod”byt
he

samebel
i
efasBenedi
ctXVIt
hat“
humanbei
ngshav
eadoubl
enat
ure:onepar
t

mor
tal
,and t
he ot
herone i
mmor
tal
”and t
hatper
sons mustent
eri
ntoa

r
elat
ionshi
pwi
tht
heet
ernalGod,andpr
epar
eforet
ernall
i
fe,bydoi
ngact
sof

l
ove,j
ust
ice,ki
ndness,andmer
cy,i
nthi
swor
ld.
” Thi
sfi
ndi
ngal
soechoest
he

r
esul
tsofar
ecentst
udyt
hatshowedal
mostal
lpat
ient
stal
kedaboutspi
ri
tual
i
ty

andt
hataccept
anceofi
l
lnesswascommonandwasmadepossi
blebecauseof

ar
eli
giousf
ait
hfoundedonbel
i
efi
nthepr
ovi
denceofGodandbel
i
eft
hatGodi
s

i
nti
mat
elypr
esenti
neachper
son'
sli
fe(
BrancheandTor
ke,2007)
.Fi
ndi
ngsof

t
hisst
udyal
sodr
awsat
tent
iont
ooneoft
hechal
l
engesofcompr
ehensi
vecar
e
f
ort
hedy
ing:at
tendi
ngt
ocomponent
sofcar
ethatar
enotnat
ural
l
yimpor
tantt
o

cl
i
nici
ansbutar
ecr
it
icalt
opat
ient
sandt
hei
rfami
l
ies.Forexampl
e,i
ncont
rast

wi
thheal
thcar
epr
ovi
der
s,pat
ient
sandf
ami
l
ymember
sal
sor
ankedt
hef
oll
owi
ng

amongt
het
opf
ivemosti
mpor
tantf
act
orsatendofl
i
fe:“
Feel
spr
epar
edt
odi
e”,

“
feel
sone’
sfami
l
yispr
epar
edf
orone’
sdeat
h”,and“t
rustone’
sdoct
or”.The

heal
thcar
epr
ovi
der
sgener
all
yemphasi
zedt
hatdy
ingpat
ient
sneededcar
ein

t
ermsoff
ami
l
yandsoci
alr
elat
ionshi
ps,phy
sicalcar
e,andi
nfor
meddeci
sion

maki
ngasshowni
nthei
rranki
ngchoi
ces.Nev
ert
hel
ess,al
lthr
eegr
oupshi
ghl
y

v
aluedat
tent
iont
ospi
ri
tual
i
ty;i
npar
ti
cul
ar,t
hei
mpor
tanceofcomi
ngt
opeace

wi
thGod.Ther
esul
tsabov
ehi
ghl
ycont
rastasi
mil
arst
udy(
Stei
nhauserand

Chr
ist
aki
s,2000)
,wer
erespondent
sranked f
reedom f
rom pai
n as most

i
mpor
tantbypat
ient
s,ber
eav
ed f
ami
l
ymember
s,phy
sici
ans,and ot
hercar
e

pr
ovi
der
s.Asexpl
ainedbyOr
iel
(1997)
,thechoi
ce“
comet
opeacewi
thGod”can

beat
tr
ibut
edt
otheFi
l
ipi
no’
sdeepsenseofr
eli
giousness;bel
i
evi
ngt
hatt
he

powerofaSupr
emeBei
ngcanal
l
evi
atet
hei
rsuf
fer
ingandt
hatpat
ient
’ssear
ch

f
ort
hemeani
ngofdeat
handdy
ingcoul
dbemani
fest
ati
onofhi
ssear
chf
ort
he

meani
ngofl
i
feorspi
ri
tual
i
ty.

I
naddi
ti
ont
obei ankedas1stmosti
ngr mpor
tantf
act
oratendofl
i
feby

t
het
hreegr
oups,t
her
eisabsenceofsi
gni
fi
cantdi
ff
erence(
Appendi
xE)among

t
het
hreegr
oupsi
nthei
rper
cept
ionoft
hef
act
or“
Comest
opeacewi
thGod”
.

Thi
ssuggest
sthatt
hei
tem “
comet
opeacewi
thGod”i
snear
lyi
dent
icali
n

i
mpor
tancef
ort
het
hreegr
oupsandt
hatt
hei
rbei ankedas1stbyt
ngr het
hree

gr
oupsar
enotmer
elycoi
nci
dent
al.
Rev
isi
ti
ngLi
ter
atur
e

Ther
esear
chr
esul
tshav
esuggest
edanew def
ini
ti
onofgooddeat
h.

Good deat
his def
ined as,f
ir
stand f
oremost
,comi
ng t
o peace wi
th God.

Compar
ingt
hisdef
ini
ti
onwi
tht
hosepr
evi
ousl
ydi
scussed,i
tbecomescl
ear
er

t
hatt
her
ewer
eunder
lyi
ngassumpt
ionst
hatwer
enotadequat
elyexpl
ained.

Themoder
nhospi
cemov
ementdef
inesagooddeat
hasonet
hati
ncl
uded

accept
anceandcl
osur
e,mostof
tenathome.I
nthi
sst
udy
,to“
dieathome”was

r
ated as ext
remel
yimpor
tantby onl
yless t
han 10 % oft
he par
ti
cipant
s.

Mor
eov
er,dy
ingathomewasconsi
stent
lynotsel
ect
edandi
ncl
udedi
nthe5

mosti
mpor
tantf
act
orsatendofl
i
fe.Thi
sinsi
nuat
est
hatal
thought
henot
ionof

dy
ingathomemaybeconsi
der
edi
dealbyt
hehospi
cemov
ementi
nor
dert
o

pr
ovi
deagooddeat
h,t
hisshoul
dnotbeassumed.Asexpl
ainedbySt
einhauser

(
2000)
,assy
mpt
omsaccel
erat
eint
hel
ast24t
o48hour
s,somepat
ient
sand

f
ami
l
iesmayf
eelov
erwhel
medbyconcer
nsaboutsy
mpt
om cont
roloradead

bodyi
nthehomeand,t
her
efor
e,pr
eferaski
l
ledcar
eenv
ironment
.Si
nce1991

t
hehospi
cemov
ementandpal
l
iat
ivecar
eint
hePhi
l
ippi
neshav
ebeenget
ti
ng

publ
i
csuppor
t.Thei
rser
vicesi
ncl
udephy
sical
,psy
chol
ogi
cal
,soci
al,spi
ri
tual
,

and ber
eav
ementsuppor
t. Howev
er,onl
yfew oft
he par
ti
cipant
sint
his

r
esear
ch’
ssampl
erat
edandsel
ect
eddy
ingathomeandf
reedom f
rom pai
nas

ext
remel
yimpor
tantat
tri
but
e atend ofl
i
fe.Mor
eov
er,dy
ing athome was

consi
stent
ly notsel
ect
edandr
ankedasoneoft
hef
ivemosti
mpor
tantf
act
ors

amongt
het
hreegr
oups.Fr
eef
rom pai
nseem t
obeassoci
atedwi
tht
her
oleof

t
hephy
sici
an,t
heheal
er.Bot
hpat
ient
sandf
ami
l
ymember
sdi
dnotconsi
deri
t
asext
remel
yimpor
tantnordi
dtheyi
ncl
udei
tamongt
het
opf
ivemosti
mpor
tant

atendofl
i
fe.Thenot
ionofdy
ingathome,accept
ance,cl
osur
eandf
reedom

f
rom pai
nmayber
omant
icamongheal
thcar
epr
ofessi
onal
swhowantt
opr
ovi
de

a good deat
h.Howev
er,dat
a suggest
sthatpat
ient
s,f
ami
l
ymember
s and

heal
thcar
epr
ofessi
onal
sper
cei
vet
hatt
ohav
eagooddeat
h,f
ir
standf
oremost
,

oneneedst
ocomet
opeacewi
thGod.I
twascl
ear
lyi
mpor
tantt
othet
hree

gr
oups,
asi
l
lust
rat
edbyt
hei
rst
rongconsensussur
roundi
ngt
heneedf
orcomi
ng

t
opeacewi
thGod.Al
though Hospi
ceandPal
l
iat
iveMedi
cineal
sopr
ovi
de

spi
ri
tualcar
e,t
his domai
n cannotbe si
mpl
ytr
eat
ed as mer
elyone oft
he

component
sofgooddeat
h.I
nfact
,basedont
hedat
agat
her
ed,i
tthemost

i
mpor
tantf
act
oratendofl
i
fe.

Ni
chol
asChr
ist
aki
ssai
dthatagooddeat
hwasconsi
der
edby96per
cent

ofAmer
icansasf
reeofpai
n,89per
centsai
diti udesnotbur
ncl deni
ngt
hef
ami
l
y

and81per dnotwantt
centdi obur
densoci
ety
.Ina2000st
udybySt
einhauser

andTul
sky
,ser
iousl
y-
il
lpat
ient
s,r
ecent
lyber
eav
edf
ami
l
ymember
s,phy
sici
ans

andheal
thcar
epr
ovi
der
sal anked f
sor reedom f
rom pai
n asmosti
mpor
tant
.

Howev
er,i
nthi
sst
udy
,onl
ythegr
oupofmor
ethan70%ofheal
thcar
epr
ovi
der
s

r
ated“
freef
rom phy
sical
pai
n”asext
remel
yimpor
tant
.Li
kewi
se,
onl
yheal
thcar
e

pr
ovi
der
ssel
ect
edandr
ankedf
reef
rom phy
sicalpai
nasoneoft
hef
ivemost

i
mpor
tantendofl
i
fef
act
ors.Thi
spr
efer
enceofheal
thcar
epr
ovi
der
sissi
mil
ar

t
oKessl
er’
sst
udy(
2000)wher
emedi
calpr
ofessi
onal
s bel
i
evet
hatnoone

shoul
dhav
etol
i
vei
npai
nordi
einpai
nandt
hatpat
ient
sandt
hei
rlov
edones

shoul
dbeawar
ethatv
eryef
fect
ivepai
nmanagementi
sav
ail
abl
e.Buti
f,asdat
a
suggest
s,spi
ri
tualsuppor
tist
hemosti
mpor
tant
,ifnott
hecor
eofcar
efort
he

dy
ing,t
henphy
sici
ansandot
herheal
thcar
epr
ovi
der
soughtt
ohel
pinpr
ovi
ding

spi
ri
tualcar
e. Hel
pfulast
heyar
e,t
hecl
ergyorchapl
ainaddr
essonl
yver
y

speci
fi
c needs especi
all
y neart
he dy
ing moment(
e.g.bl
essi
ng,anoi
nti
ng,

conf
essi
on,communi
on,et
c.) Ther
ear
emanyspi
ri
tualconcer
nswhi
chcome

waybef
oret
heact
ualdy
ingmomentt
hatneedt
obeaddr
essed.I
tmi
ghtseem

unr
eal
i
sti
cforheal
thcar
epr
ovi
der
stoshi
ftr
olesf
rom amedi
caldoct
ort
oa

spi
ri
tualadv
iser
.Buti
fthati
sthecase,
thendoct
orsoughtnott
obei
nchar
geof

t
hecar
eoft
het
ermi
nal
l
y-i
l
l.Thei
rmedi
calr
olewoul
dappearsecondar
ysi
nce

t
hei
mpor
tantneedoft
hedy
ingi
sspi
ri
tual
.Thehospi
cehasal
readymov
edt
o

t
hisdi
rect
ion,
howev
eri
fphy
sici
ansandot
herheal
thcar
epr
ovi
der
sreal
l
ywantt
o

car
efort
hedy
ing,t
hent
heyoughtt
olear
n,know andpr
ovi
despi
ri
tualcar
efor

t
hei
rpat
ient
s.

I
nast
udyent
it
ledTheFut
ureofHeal
thandCar
eofOl
derPeopl
e(1999)
,

gooddeat
hhasbeendef
inedasnotmer
elyabsenceofpai
n.I
tal
sohadf
ori
ts

t
hemet sofaut
heconcept onomy
,cont
rolandi
ndependence.Buti
nthi
sst
udy
,

“
fol
l
owwi
shesofpat
ient
”fi
gur
edv
eryl
owi
nter
msofi
tbei
ngr
atedasext
remel
y

i
mpor
tantbyt
het
hreegr
oups. Si
mil
arl
y,“
fol
l
ow wi
shesofpat
ient
”wasnot

sel
ect
edandr
ankedasmosti
mpor
tantatendofl
i
fe.I
nHi
nes’(
2001)st
udy
,

r
esul
tsshowedt
hatsur
rogat
eswant
edwr
it
tenandor
ali
nst
ruct
ionsmor
eof
ten

t
han pat
ient
s want
ed t
o pr
ovi
de t
hem. Pat
ientaut
onomy has been wel
l

emphasi
zedasi
nval
uabl
etopat
ient
syetr
esul
tsoft
hisst
udyshowot
her
wise.I
t

i
spr
obabl
yfort
hist
hatKass(
2005)hasbeende-
str
essi
ngaut
onomysay
ingt
hat
humani
nter
dependencer
athert
hani
ndependencepr
ovi
dest
heneedofhuman

pr
esenceonesomuchneedswhenonecannotcar
eforonesel
fany
mor
e.I
n

t
ermsofdeat
handdy
ing,whati
scur
rent
lybei
ngpl
ayedoutmor
einbi
oet
hicsi
s

t
het
hemeofsel
f-
det
ermi
nat
ionandaut
onomy
.Hav
ingbeenest
abl
i
shedasa

secul
ardi
sci
pli
net
hatanswer
swhet
herone’
sconducti
sri
ghtorwr
ongi
nthe

f
iel
dofmedi
ci
neandl
i
fesci
ences,
bioet
hicst
ri
eshar
dtomakei
tssy
stemat
ized

bodyofknowl
edge. Buti
ndy
ing,spi
ri
tual
i
tyi
sar
oused,t
hati
s,t
heper
son

becomesmor
econsci
oust
hathei
saspi
ri
tualbei
ng.Bei
ngdef
inedasasecul
ar

di
sci
pli
ne,how canbi
oet
hicsaddr
esst
hespi
ri
tuali
ssuet
hati
sinher
entt
othe

needsofady
ingpat
ient
? Thi
simpl
i
est
hatbi
oet
hicsoughtt
otackl
eser
iousl
y

spi
ri
tuali
ssuesaswel
l
. I
nthi
sst
udy
,pat
ient
s,f
ami
l
ymember
sand ev
en

heal
thcar
epr
ovi
der
sagr
eedt
hatcomet
opeacewi
thGodi
sthemosti
mpor
tant

f
act
oratendofl
i
fe.Thei
rper
cept
ionssuggestt
hatt
heyconsi
dert
hemsel
ves

spi
ri
tualbei
ngs.Andt
hisappear
stobet
hecommondenomi
nat
oramongt
he

t
hreegr
oups.

Sheenan(
2000)
,bel
i
evest
hatdy
ingwel
lhast
hreeessent
ialcomponent
s:

pr
opermedi
calcar
e,sensi
ti
vi
tyt
other
eli
giousandspi
ri
tualv
alues,andl
i
ving

wel
lwi
thGod. Somef
act
orsundermedi
calcar
eappeari
nthi
sst
udyas

ext
remel
yimpor
tant
,butonl
yformor
ethan70% ofheal
thcar
epr
ovi
der
s. An

at
tr
ibut
eundermedi
calcar
ewassel
ect anked4thand5thonl
edandr ybypat
ient
s

andf
ami
l
ymember
s,r
espect
ivel
y.Nodoubt
,medi
cal
car
eisi
ndi
spensabl
eint
he

car
efordy
ingpat
ient
s;howev
er,spi
ri
tualsuppor
t/car
econst
ant
lycameoutas

mosti
mpor
tanti
nthi
sresear
ch.Li
keBr
anchandTor
ke(
2007)
,resul
tsoft
his
st
udysuggestt
hat spi
ri
tual
i
tyandmedi
calcar
ear
enotseenasconf
li
cti
ng.I
t

can be concl
uded,l
i
ke t
hem,t
hataccept
ance ofi
l
lnesst
hrough spi
ri
tual
i
ty

benef
it
edt
hepat
ient
sandwasnotcont
radi
cti
ngdesi
ref
ormedi
calcar
e.And

t
hisi
deacanexpl
aint
hei
nsi
stenceofBenedi
ctXVIt
hatt
hewhol
eper
sonmust

becar
edf
orbot
hphy
sical
l
yandspi
ri
tual
l
y.

RECOMMENDATI
ONS

Fi
rst
,besi
desmaki
ngpast
or e1 av
alcar ail
abl
einhospi
ceandpal
l
iat
ive

car
ecent
ersi
nthePhi
l
ippi
nes,
heal
thcar
epr
ovi
der
sthemsel
vesneedt
oaddr
ess

mor
ethespi
ri
tualneedsoft
hepat
ient
s.Thi
scoul
dincl
udeengagi
ngpat
ient
sin

conv
ersat
ionsaboutt
hei
rspi
ri
tual
i
ty,t
heai
m ofwhi
ch i
stol
i
sten t
o what

pat
ient
ssayt
hei
rneedsar
eandt
olett
hem knowt
hatt
hei
rbel
i
efsar
erespect
ed.

Thi
spr
act
icewi
l
lhel
pval
i
dat
ethepat
ient
’sspi
ri
tual
i
tyandcoul
dther
efor
ehel
p

car
epr
ovi
der
sinof
fer
ingsour
cesofcomf
ortatendofl
i
fe.

Second,t
oputemphasi
soncul
tur
alandspi
ri
tualsensi
ti
vi
tyi
nthet
rai
ning

off
utur
e heal
thcar
e pr
ovi
der
s. These wi
l
lhel
pthem under
stand pat
ient
s’

spi
ri
tualcor
ebel
i
efswhi
chi
ntur
ncoul
dgr
eat
lyf
aci
l
itat
ethei
rabi
l
ityt
ohonort
he

dy
ingpat
ient
'
swi
shes.Besi
des,heal
thcar
epr
ovi
der
swi
l
lreal
i
zehow t
hei
rown

spi
ri
tualbel
i
efssy
stemsaf
fectt
hecar
etheypr
ovi
de.I
nthePhi
l
ippi
nes,t
rai
ning

coul
dincl
ude l
ect
ures,smal
lgr
oup di
scussi
ons,act
ualpat
ienti
nter
views,

r
eadi
ngsandon-
cal
lexper
iencewi
thahospi
tal
chapl
ainorpast
or.

Thi
rd,t
hatspi
ri
tuali
ssuesbedi
scussedi
nbi
oet
hicsi
fgoodcar
efort
he

1
TheSupport
ivePal
li
ati
veandHospi ceCareCli
nic-
UP-PGHalreadyof
fer
spastoral
carei
n
coordi
nati
onwit
hthesist
ersSt.Paul
.Si nce2007,spi
ri
tual
assessmentandcarehasbeen
i
ntegrat
edint
othei
rresi
dents’
curri
culum.
dy
ingi
sit
sconcer
n.I
nthePhi
l
ippi
necont
extspi
ri
tualsuppor
tiswhatconcer
ns

pat
ient
sandf
ami
l
y.Ther
efor
e,bi
oet
hicsneedst
oal
sof
ocusont
heet
hical

concer
nsofspi
ri
tual
i
tyandnotj
ustcent
ert
oomuchont
reat
mentdeci
sions,

suchaswhent
oof
fer
,wi
thhol
d,andwi
thdr
awv
ari
oust
reat
ment
s.

Four
th,t
hatsi
mil
arst
udi
eswi
thabi
ggersampl
esi
zebeconduct
edi
n

ot
heri
nst
it
uti
onswi
thhospi
cesandpal
l
iat
ivecar
ecent
erssoast
oaugmentdat
a

onf
act
orsassoci
atedwi
thgooddeat
hint
hePhi
l
ippi
necont
ext
.

Fi
ft
h,t
hatt
hisst
udybeusedasaspr
ingboar
dtoexpl
oret
hef
act
or“
come

t
opeacewi
thGod”si
ncei
tiscl
eart
hatv
eryl
i
ttl
eexi
stsi
nli
ter
atur
ewi
thi
nthe

Phi
l
ippi
necont
extabout“
comet
opeacewi
thGod”i
ngener
al. Acr
it
icaland

r
efl
ect
ivest
udyof“
comet
opeacewi
thGod”atendofl
i
fecandef
ini
tel
ypr
ovi
dea

pr
ofoundandr
igor
ousi
ntel
l
ect
ualcont
ri
but
ion,mor
eespeci
all
y,i
nthef
iel
dsof

medi
cine,
phi
l
osophy
,andbi
oet
hics.
BI
BLI
OGRAPHY
 BI
BLI
OGRAPHY

Abi
ng-
Sabel
li
naM.&Ani ceto,
E.G.(1996,Jan-
Jun).Compari
sonofAtti
tudesof
Terminal
ly-
Il
lLung Cancer Pati
ents with thei
r Rel
ati
ves on certai
n
Psychosoci
alIssuesRegardi
ngLungCanceri nitsTermi
nalStageatthe
LungCenterofthePhil
i nes.Sci
ppi entProc,Vol.4(1)
:75-
79.

AdanzaandMart
inez
.( .Met
2002) hodsofResear
chf
orHeal
thPr
ofessi
ons.
Manil
a:RexPubl
ishi
ngInc.

Badash,M.(2008, February.Heal
) t
hLibrar
y.Retri
evedMar ch18,2008 f
rom
htt
p:/
/www. eli
b.gov.ph/edat
abase/el
ibget
db.php/
http/heal
thl
i
brary.
epnet.com/ GetContent.
aspx?t
oken=38405ca3-6cab-
4817-9cba-
dc64dc5c69f1&chunki i
d=22825

Bar
agan,J.(2007).HomilyoftheXVWor l
dDayoftheSick.Ret
ri
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 APPENDI
CES

Appendi
xA

I
mpor
tanceofFact
orsRel
atedToEndofLi
feAsPer
cei
ved
 ByPat
ient
s

Rank HowImportantAreTheFol
lowingFact
orsAsthey Ext
remely Domai
n
ApplyTotheLastMonthsofLi
fe? I
mportant
1 comestopeacewi t
hGod 26(74.3) Spi
rit
ualsupport
2 pray 21(60.0) Spir
it
ualsuppor
t
3 chancet
oresolveconf
li
ctswi
thfamil
yorfr
iends Soci
alRel
ati
onships
22(
62.
9) andFamilySupport
4 pr
esenceoff
ami
l
ymember
s Soci
alRel
ati
onships
20(
57.
1) andFamilySupport
5 chancet
osaygoodby
etoi
mpor
tantpeopl
einone’
sli
fe Soci
alRel
ati
onships
17(
48.
6) andFamilySupport
6-
8 bef reeofphy sical painandsy mpt oms( shortnessof
breat h, i
tchi ness, etc) 16(45.
7) 2
notdi eal one 16(45.
7) 3
trustsone’ sdoct or 16(45.
7) 6
9 bev i
sitedbyapr iestorpast orf rom chur ch 13(37.
1)
10 bekeptcl ean, war m, andcomf ortabl e 12(34.
3) 2
11-
15 readst heBi bleorot herspi ri
tual readi ngmat eri
al s 11(31.
4) 5
receiv esbl essingf ort hesi ck/sacr ament s 11(31.
4) 5
begi v enf ood 11(31.
4) 2
knowswhatt oexpectf rom hiscondi ti
on 11(31.
4) 1
feelst hatone’ sf ami l
yispr epar edf orone’ sdeat h 11(31.
4) 7
16-
17 feelspr epar edt odi e 10(28.
6) 7
bement allyawar eandf reeofanxi ety 10(28.
6) 7
18 knowswhatt oexpectf rom t hemedi cal tr
eatment 9(
25.7) 1
19-
20 receiv escar ef rom one’ sownper sonal doctor 8(
22.9) 6
feelshe/ shei snotabur dent oot her s 8(
22.9) 7
21-
22 hasadoct orwhopr ovideshol isticcar e 7(
20.0) 6
knowsone’ scondi tionf rom thedoct or 7(
20.0) 1
23 hasanur sewi t
hwhom onef eelscomf or t
able 6(
17.1) 6
24 knowsot herav ailabl efor msoft reat ment 5(
14.3) 1
25-
27 beact ivel yinvol vedi ndeci si
on- maki ngaboutt reatment
plan 4(
11.
4) 1
feelshe/ shei snotabur dent osoci ety 4(
11.
4) 7
one’ sdoct oriscomf ort
abl etalkingaboutdeat hand
dy i
ng 4(
11.
4) 5
28-
30 namesomeonet omakedeci sionsi nt heev entt hat
he/ shecannotmaket hem f oronesel f 3(
8.6) 4
hav ef inancesi nor der 3(
8.6) 4
dieathome 3(
8.6) 3
31-
32 begi v enmedi cat ionsev eni fitcoul dcausesi deef fect
s
suchasr espirat or ydepr ession 3(
8.6) 2
notconnect edt omachi nes 3(
8.6) 2
33-
35 hav et reat mentpr ef erencei nwr iting 1(
2.9) 4
foll
owwi shesoft hepat ient 1(
2.9) 4
usel essexpensi v et reatmentandmedi cati
on 1(
2.9) 4

Appendi
xB

I
mpor
tanceofFact
orsRelat
edToEndofLi
feAsPer
cei
vedby
Famil
yMembers
 Appendi
xC

Rank HowImport
antAreTheFol
lowi
ngFact
orsAst
hey Ext
remely Domai
n
ApplyTotheLastMont
hsofLi
fe? I
mportant
1 comestopeacewit
hGod 23(56.1) Spi
ritualsuppor
t
2 notdi
eal
one Soci
al
Rel
ationshipsand
18(
43.
9) Famil
ySuppor t
3 pr
esenceoff
ami
l
ymember
s Soci
al
Rel
ationshipsand
18(
43.
9) Famil
ySuppor t
4 begi v enf ood 17(
41.
5) PhysicalComfort
5 bef reeofphy sical painandsy mpt oms( shor tnessof
breat h, i
tchi ness, etc) 16(
39.
0) Phy
sical
Comf
ort
6 hasachancet or esol v
econf li
ctswi t
hf ami l
yorf ri
ends 15(
36.
6) 3
7-
9 feelst hatone’ sf ami lyispr epar edf orone’ sdeat h 13(
31.
7) 7
feelspr epar edt odi e 13(
31.
7) 7
patientpr ays 13(
31.
7) 5
10 receiv esbl essingf ort hesi ck/sacr ament s 12(
29.
3) 5
11 readst heBi bleorot herspi ri
tual readi ngmat eri
al s 11(
26.
8) 5
12 bev i
sitedbyapr iestorpast orf rom chur ch 10(
24.
4) 5
13-
15 hasachancet osaygoodby et oimpor t antpeopl ein
one’ slife 9(
22.
5) 3
trustsone’ sdoct or 9(
22.
0) 6
bekeptcl ean, war m, andcomf ortable 9(
22.
0) 2
16-
19 bement allyawar eandf reeofanxi ety 8(
19.
5) 7
hasanur sewi thwhom onef eelscomf ortabl e 8(
19.
5) 6
beact ivel yinvol vedi ndeci si
on- maki ngaboutt reatment
plan 8(
19.5) 1
knowswhatt oexpectf rom hi scondi tion 8(
19.5) 1
20-
22 receiv escar ef rom one’ sownper sonal doct or 6(
14.6) 6
knowsone’ scondi tionf rom thedoct or 6(
14.6) 1
knowswhatt oexpectf rom t hemedi cal tr
eat ment 6(
14.6) 1
23 hav ef inancesi nor der 5(
12.2) 4
24-
26 dieathome 4(9.
8) 3
feelshe/ shei snotabur dent oot hers 4(9.
8) 7
begi v enmedi cat ionsev eni fitcoul dcausesi deef fect
s
suchasr espirat or ydepr ession 4(
9.8) 2
27-
30 foll
owwi shesoft hepat ient 3(
7.3) 4
hasadoct orwhopr ovideshol i
sticcar e 3(
7.3) 6
knowsot herav ailabl efor msoft reatment 3(
7.3) 1
feelshe/ shei snotabur dent osoci et y 3(
7.3) 7
31-
34 Hav et reat mentpr eferencei nwr i
ting 2(
4.9) 4
namesomeonet omakedeci sionsi nt heev entt hat
he/ shecannotmaket hem f oronesel f 2(
4.9) 4
one’ sdoct oriscomf ort
abl etalkingaboutdeat hand
dy i
ng 2(
4.9) 6
notconnect edt omachi nes 2(
4.9) 2
35 usel essexpensi v et reatmentandmedi cation 0(
0.0) 4

I
mpor
tanceofFact
orsRel
atedToEndofLi
feAsPer
cei
vedby
Heal
thcar
eProvi
der
s
Rank HowI mportantAreTheFol
lowingFact
orsAstheyAppl
y Ext
remely Domai
n
TotheLastMonthsofLif
e? Impor
tant
1 hasachancet osaygoodbyetoimport
antpeopl
ein Soci
alRelationships
one’sli
fe 31(
91.
2) andFamilySuppor t
2 presenceoffamil
ymember s Soci
alRelationships
27(
79.
4) andFamilySuppor t
3-
4 bekeptcl
ean,war
m, andcomfor
tabl
e 26(
78.
8) Physi
cal Comf ort
knowswhattoexpectfr
om hi
scondi
tion Communi cationand
Inf
ormedDeci sion-
26(
78.
8) Maki ng
5-
7 f
eel
spr
epar
edt
odi
e SenseofEmot ional
26(
76.
5) Well
-being
trustsone’ sdoct or 26(
76.
5) 6
hasachancet or esol veconflictswi thf ami lyorf ri
ends 26(
76.
5) 3
8-
9 beact ivelyinvolv edi ndecision- maki ngaboutt reatment
plan 25(
75.
8) 1
knowswhatt oexpectf rom themedi calt reatment 25(
75.
8) 1
10 hasadoct orwhopr ov i
deshol isticcare 25(
73.
5) 6
11-
12 bef reeofphy sicalpai nandsy mpt oms( shor tnessof
breat h, i
tchiness, etc) 24(
72.
7) 2
knowsone’ scondi t
ionf rom thedoct or 24(
72.
7) 1
13 feelst hatone’ sf ami lyisprepar edf orone’ sdeat h 22(
66.
7) 7
14-
15 bement allyawar eandf r
eeofanxi ety 22(
64.
7) 7
comet opeacewi thGod 22(
64.
7) 5
16 one’ sdoct ori
scomf or t
abletalkingaboutdeat handdy ing 21(
61.
8) 6
17 knowsot herav ailablef ormsoft reatment 20(
60.
6) 1
18 notdi eal one 20(
58.
8) 3
19-
20 namesomeonet omakedeci sionsi ntheev entt hat
he/ shecannotmaket hem foronesel f 19(
55.9) 4
feelshe/ sheisnotabur dentoot hers 19(
55.9) 7
21 patientpr ays 18(
52.9) 5
22-
23 begi venf ood 17(
51.5) 2
Hav et reat mentpr eferenceinwr i
ting 17(
50.0) 4
24 foll
owwi shesoft hepat i
ent 15(
45.5) 4
25-
26 feelshe/ sheisnotabur dentosoci ety 15(
44.1) 7
receiv escar ef r
om one’ sownper sonal doct or 15(
44.1) 6
27 bev i
sitedbyapr iestorpast orf rom chur ch 14(
41.2) 5
28 fi
nancesi norder 13(
38.2) 4
29-
30 readst heBi bleorot herspiri
tual readingmat erials 12(
35.3) 5
receiv esbl essingf ort hesick/sacr ament s 12(
35.3) 5
31 hasanur sewi thwhom onef eelscomf or table 10(
29.4) 6
32 usel essexpensi vet reatmentandmedi cat i
on 8(24.
2) 4
33 begi venmedi cationsev enifitcoul dcausesi deef fect
s
suchasr espirator ydepr essi
on 6(
19.4) 2
34 notconnect edt omachi nes 4(
12.9) 2
35 di eathome 3(8.
8) 3

Appendi
xD
MeanRankScor
esof5MostI
mpor
tantFact
orsatEndofLi
feby
EachGr
oup
Fact
ors Pat
ient
s Fami
ly Heal
thcar
e
 Member
s Pr
ovi
der
s

Comest
opeacewi
thGod 2.
43(
1) 2.
27(
1) 1.
59(
1)

Feel
spr
epar
edt
odi
e 2.
08(
2) 1.
66(
2) 0.
88

Feel
sthatone’
sfami
l
yispr
epar
edf
or
one’
sdeath 1.
63(
3) 1.
51(
3) 0.
12

Notdi
eal
one 1.
23(
4) 0.
53

Tr
ust
sone’
sdoct
or 1.
14(
5) 1.
27(
4) 0.
26

Chancetoresol
veconf
li
ctswi
thf
ami
l
y
orfr
iends 0.
74 1.
22(
5) 0.
62

Pr
esenceoff
ami
l
ymember
s 0.
57 0.
32 1.
12(
2)

Knowswhatt
oexpectf
rom hi
s
condi
ti
on 0.
54 0.
68 1.
12(
3)

Bef r
eeofphysi
cal
painandsy mptoms
(short
nessofbr
eath,
itchi
ness,et
c)
0.
57 0.
61 0.
91(
4)

Beact i
velyi
nvolvedindeci
sion-
making
aboutt r
eatmentplan 0.08 0.54 0.88(
5)
*Factorsarel
istedinthemeanr ankorderbasedonallt
hepar
ti
cipants’
response.Number
sin
parenthesesaremeanr ankorderwit
h1i ndicat
ingt
hemostimportantf
actor.

Appendi
xE
Summar
yTabl
eofschef
feMult
ipl
eCompar
isonTest
sforSi
gni
fi
cantDi
ff
erence
inmeanScoresamongt
heThreeGroups

Fact
ors Comput
ed I
nter
pret
ati
on
schef
fet
est
Thatt
hepat
ientcomestopeacewit
hGod 0.
18 NotSi
gni
fi
cant
Thatt
hepat
ientfeel
spr
eparedtodi
e
0.
02 Si
gni
fi
cant
Thatt
hepati
entfeel
sthatone’
sfami
l
yis
pr
epar
edforone’
sdeath 0.
00 Si
gni
fi
cant
Thatt
hepati
entdoesnotdieal
one
0.
08 NotSi
gni
fi
cant
Thatt
hepat
ientt
rust
sone’
sdoct
or
0.
01 Si
gni
fi
cant
Thatthepati
enthasachancetor
esol
ve
conf
li
ctswit
hfamilyorf
ri
ends
0.
18 NotSi
gni
fi
cant
Thatt
hepat
ienthast
hepr
esenceoff
ami
l
y
members
0.
03 Si
gni
fi
cant
Thatt
hepat
ientknowswhatt
oexpectf
rom hi
s
condi
ti
on
0.
27 NotSi
gni
fi
cant
Thatt
hepati
entbefr
eeofphy
sicalpainand
sy
mptoms(short
nessofbr
eat
h,it
chiness,et
c)

0.
54 NotSi
gni
fi
cant
Thatthepat
ientbeact
ivel
yinv
olv
edi
ndeci
si
on-
makingabouttreat
mentpl
an 0.
04 Si
gni
fi
cant