The aim of this study was to develop a measure for evaluating good death from the bereaved family member's perspective, and to examine the validity and reliability of the assessment. A cross-sectional anonymous questionnaire was administered to bereaved family members of cancer patients who had died in a regional cancer center from September 2004 to February 2006. We measured the Good Death Inventory (GDI), Care Evaluation Scale, and an overall care satisfaction scale. A retest was conducted one month after sending the questionnaire. Of the 344 questionnaires sent to bereaved family members, 189 responses were analyzed (57%). A factor analysis of the responses to the GDI identified 10 core domains: ''environmental comfort,'' ''life completion,'' ''dying in a favorite place,'' ''maintaining hope and pleasure,'' ''independence,'' ''physical and psychological comfort,'' ''good relationship with medical staff,'' ''not being a burden to others,'' ''good relationship with family,'' and ''being respected as an individual.'' Eight optional domains also were identified: ''religious and spiritual comfort,'' ''receiving enough treatment,'' ''control over the future,'' ''feeling that one's life is worth living,'' ''unawareness of death,'' ''pride and beauty,'' ''natural death,'' and ''preparation for death.'' The GDI had sufficient concurrent validity with the Care Evaluation Scale and overall care satisfaction, sufficient internal consistency (alpha ¼ 0.74e0.95), and acceptable testeretest reliability (ICC ¼ 0.38e0.72). Finally, we developed a short version of the GDI. The GDI is a valid scale to measure end-of-life care comprehensive outcomes from the bereaved family member's perspective in Japan. J Pain Symptom Manage

Background: The aims of this study were to (i) conceptualize dimensions of a good death in Japanese cancer care,(ii) clarify the relative importance of each component of a good death and (iii) explore factors related to an individual's perception of the domains of a good death. Methods:The general population was sampled using a stratified random sampling method (n = 2548; response rate, 51%) and bereaved families from 12 certified palliative care units were surveyed as well (n = 513; 70%). We asked the subjects about the relative importance of 57 components of a good death.Results: Explanatory factor analysis demonstrated 18 domains contributing to a good death. Ten domains were classified as Ôconsistently important domainsÕ, including Ôphysical and psychological comfortÕ, Ôdying in a favorite placeÕ, Ôgood relationship with medical staffÕ, Ômaintaining hope and pleasureÕ, Ônot being a burden to othersÕ, Ôgood relationship with familyÕ, Ôphysical and cognitive controlÕ, Ôenvironmental comfortÕ, Ôbeing respected as an individualÕ and Ôlife completionÕ. Conclusions:We quantitatively identified 18 important domains that contribute to a good death in Japanese cancer care. The next step of our work should be to conduct a national survey to identify what is required to achieve a good death.

One of the most important goals of palliative care is achieving a "good death" or a "good dying process." The primary aim of this study was to identify the components of a Japanese "good death" through qualitative interviews with cancer patients, their families, physicians, and nurses. Semistructured interviews were conducted. Thirteen advanced cancer patients, 10 family members of such patients, 20 physicians, and 20 nurses were recruited from five regional cancer institutions in Japan. Content analysis was applied to answers, and 58 attributes were extracted and classified into 17 categories as follows: Freedom from pain or physical/psychological symptoms, Having a good family relationship, Dying in one's favorite place/environment, Having a good relationship with medical staff, Not being a burden to others, Maintaining dignity, Completion of life, Maintaining a sense of control, Fighting against cancer, Maintaining hope, Not prolonging life, Contributing to others, Control of future, Not being aware of death, Appreciating others, Maintaining pride, and Having faith. The most frequently cited category was "Freedom from pain or physical/psychological symptoms" and the least common was "Having faith." This study identified important components of a good death in Japan. A future quantitative survey is planned to clarify the generalizability of these findings as the primary endpoint of palliative care in Japan.