Perceived Importance of Good Death Components Among Patients With Advanced Cancer and Family Caregivers

Importance Although the concept of a good death is central to palliative care policy and practice, empirical evidence is largely derived from high-income Western or single-country contexts, limiting cross-setting relevance.

Objective To determine the importance of good death components, compare priorities across settings, and examine patient–caregiver differences and setting-by-role interactions.

Design, Setting, and Participants This cross-sectional study was conducted from March 2023 to February 2025 using the 54-item Good Death Inventory. Adults with stage III or IV cancer and family caregivers were recruited from oncology and palliative care services in Hong Kong, mainland China, Turkey, Greece, and Gaza.

Main Outcomes and Measures Primary outcomes were Good Death Inventory importance scores (including total, core domains, and optional domains). Internal consistency was assessed using Cronbach α, and group differences were analyzed using analysis of variance, with partial η2 used to estimate effect size.

Results The final analysis included 1059 participants: 640 patients (60.4%) and 419 family caregivers (39.6%) (mean [SD] age, 50.8 [18.8] years; 547 of 1056 participants with sex data [51.7%] were female). The Good Death Inventory demonstrated excellent internal consistency across settings (Cronbach α = 0.94). Mean total Good Death Inventory scores differed significantly across settings (partial η2 = 0.383; P < .001). Scores were highest in Gaza (mean [SD], 5.93 [0.56]) and Greece (5.88 [0.30]), where participants placed greater emphasis on emotional peace, family harmony, and spiritual acceptance. Scores were lowest in Turkey (mean [SD], 4.71 [0.87]) and Hong Kong (4.93 [0.71]). Patient–caregiver differences were generally small, although minor setting-by-role interactions suggest context-specific variation in priorities.

Conclusions and Relevance In this cross-sectional study, patients with advanced cancer and family caregivers across 5 settings shared a broad aspiration for a good death, but priorities varied across settings. Emotional peace, dignity, and family connection were consistently highly valued. These findings suggest that culturally sensitive palliative care models should recognize both shared end-of-life priorities and setting-specific meanings of a good death.