Quality of death according to the peaceful end-of-life theory in a hospice in southern Brazil.

Abstract

e24048 Background: The peaceful end-of-life theory is grounded in five central concepts: absence of pain, a state of peace, proximity to significant others, experience of comfort, and maintenance of dignity and respect. Considering that palliative care aims to promote quality of life until the end, it becomes essential to evaluate the quality of death of patients receiving exclusive palliative care. Such evaluation enables an understanding of the effectiveness of care interventions and the identification of opportunities for improvement in end-of-life care, especially in specialized hospice settings. Therefore, this study aimed to evaluate the quality of death of patients receiving exclusive palliative care in a hospice setting, according to the peaceful end-of-life theory. Methods: This is an observational, descriptive, cross-sectional study with a quantitative and qualitative approach, conducted in a hospice within an oncology hospital in southern Brazil. Throughout the year 2025, nurses in the unit were trained to complete a standardized form after patient death, assessing whether the patient was pain-free, comfortable, at peace, and accompanied by significant others during the 24 hours preceding death. Responses were categorized as “yes” or “no”. Data were tabulated and subjected to critical analysis. Results: In 2025, 610 deaths occurred in the unit. After exclusion of 27 cases without completed forms, 583 records were analyzed. Of these, 513 patients (86.35%) received a “yes” response for all evaluated items. In 70 deaths (13.65%), one or more “no” responses were recorded, initially totaling 81 negative responses. After exclusion of responses considered erroneous, 62 “no” responses remained, including 5 related to the presence of pain, 7 to lack of comfort, 6 to lack of peace, and 44 to absence of companions during the 24 hours preceding death. Conclusions: Most patients admitted to the advanced palliative care unit experienced a peaceful end-of-life, in accordance with all pillars of the analyzed theory. The absence of significant others during the last 24 hours of life emerged as the main factor associated with nonconformity with a peaceful end-of-life, accounting for 70.98% of nonconforming responses. This finding prompts reflection on contemporary lifestyles and on the guidance provided to families throughout the disease trajectory, indicating a priority area for care interventions.