Outcomes of palliative care on the quality of death in actively dying patient at Nakornping Hospital, Chiang Mai

Abstract

Introduction: The actively dying phase is a natural process often compromised by unnecessary medical interventions. Achieving a "good death" is the primary goal of end-of-life care. Timely diagnosis of imminent death and integrated palliative care empower patients to die with dignity while mitigating the psychological impact on their families. Despite its importance, empirical evidence regarding death quality and bereavement grief in Thai hospital settings remains scarce.

Objective: To evaluate the effects of palliative care on the quality of death in actively dying patients and the subsequent bereavement grief experienced by their relatives or caregivers at Nakornping Hospital

Methods: : This prospective cohort study followed 20 caregivers of patients who died at the hospital between October 2024 and September 2025. Participants were categorized into a palliative care group (n=10) and a standard care group (n=10). Instruments used were the Thai versions of the Quality of Dying and Death Questionnaire and the Inventory of Complicated Grief. Data were analyzed using descriptive statistics, Mann-Whitney U Test, and Spearman’s correlation.

Results: The palliative care group demonstrated significantly higher median QODD scores across all dimensions compared to the standard group, both during the actively dying phase [9.16 (IQR 9.06-9.44) vs 5.56 (IQR 5.38-5.88), p = 0.002] and at the time of death [9.17 (IQR 9.00-9.17) vs 5.47 (IQR 5.27-5.60), p = 0.002]. Specifically, symptom management and preparation for death showed the most significant improvements. Regarding grief, no significant difference was observed between the palliative group [29.50 (IQR 23.00-38.00)] and the standard group [34.50 (IQR 29.00-38.00), p = 0.570]. Both groups exhibited high rates of complicated grief (70% and 80%, respectively). Furthermore, no significant correlation was found between death quality and grief levels (r = -0.21, p = 0.373)

Conclusion: Palliative care significantly enhances the quality of death to an excellent level compared to standard care. However, it did not significantly reduce acute bereavement grief among relatives, likely due to the short follow-up period and other mediating social factors. Long-term longitudinal studies are recommended to monitor grief trajectories and recovery rates.