As Death Nears, Quality of Life Priorities More Likely to Shift for the Terminally ill, Yale Researchers Suggest

Religion, communication and control take precedence over physical symptoms and functioning at the end of life for some terminally ill patients, Yale researchers suggest in a new book, which examines the complex issues surrounding death and dying.

“Our review proposes that quality of life is dynamic at the end of life and the components that make up quality of life may shift, making some more important than others, depending on how close one is to death,” said Elizabeth Bradley, assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine.

The research results are published as a chapter in “Focus on the End of Life: Scientific and Social Issues,” by M. Powell Lawton. The book is part of a well-established, prestigious series by the Annual Review of Gerontology and Geriatrics, which examines and appraises current progress in research, clinical practice and program development across disciplines-from psychology, biology, and medicine to social issues and public policy.

The volume brings together the latest research on issues around death and dying, life’s attributes as it nears death, planning and preparation for death, and care and intervention-related issues.

“By focusing on quality of life at the end of life, the book re-orients us to the life, rather than the death, of terminally ill individuals,” said Bradley. “Our chapter highlights some of the components of quality of life-such as religiosity, communication, and control-that have been less studied than physical symptoms and functioning, but may be particularly important as death becomes imminent.”

Bradley said much of the discourse concerning death and dying focuses on the relief of the pain and suffering associated with death, rather than the broader idea of quality of life in the end of life. Pain is the symptom most studied in terminally ill patients, and some studies indicate that between 20 and 70 percent of dying patients are inadequately treated for pain. Fatigue, drowsiness, nausea, shortness of breath, and insomnia are among the other commonly studied physical symptoms among dying patients, but Bradley says more research is needed on quality of life.

“Future research could be used to design interventions to promote better quality of life during the different stages of terminal illness,” said Bradley. “Interventions may include new clinical practices and/or enhanced recognition and use of community-based resources to promote effective physical, emotional, social, and spiritual support of individuals in the end of life.”

In the chapter, Bradley and her colleagues note that much of the literature concerning religiousness and spirituality in the end of life implies that religious beliefs provide comfort, meaning, a sense of continuity, and a better quality of life for terminally ill individuals. In fact, recent efforts in the United States to improve the care of the dying invariably call for increased attention to the spiritual needs of patients.

“Efforts to provide answers to fundamental questions surrounding quality of life, can help further shape clinical practice and research to benefit terminally ill patients and their families in the future,” said Bradley.

Bradley’s co-authors on the chapter include Terri R. Fried, M.D., Stanislav V. Kasl at Yale, and Ellen Idler at Rutgers University.

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Karen N. Peart: karen.peart@yale.edu, 203-432-1326