Understanding the concept of ‘good death’ across cultures: A comparative study of patients and family caregivers in five countries

Although the concept of a ‘good death’ is widely discussed, its meaning is shaped by cultural, social, and spiritual contexts that define dignity, family roles, and acceptance of death. Western perspectives emphasise autonomy and symptom control, while  Eastern and Middle Eastern traditions stress harmony, filial duty, and spiritual readiness. Comparative cross-national research, however, remains scarce.

This study examined cultural differences in perceptions of a good death among patients with advanced cancer and their family caregivers across Hong Kong, Mainland China, Turkey, Greece, and Gaza, using the Good Death Inventory (GDI).

A cross-sectional comparative study was conducted with 987 participants (649 patients and 338 family caregivers) recruited from oncology and palliative-care settings in five settings. The 54-item GDI, encompassing ten core and eight additional domains, was administered in locally adapted language versions. Internal reliability was assessed using Cronbach’s α, and group differences were analysed using one-way and two-way analyses of variance (ANOVA) with partial η² as effect size.

The GDI demonstrated excellent internal consistency overall (α=0·95) and across settings (α=0·87–0·94). Significant cross-country differences were observed for the GDI total score (F(4,936) = 153·5, p<0·001, η²=0·40) and domain scores (η²=0·43 and 0·29 for core and additional domains, respectively). Participants from Gaza and China reported the highest perspectives of good death characteristics, whereas those from Turkey and Hong Kong reported the lowest. Participant (patient vs caregiver) had no main effect, though small Country× Participant interactions were identified (η²=0·012–0·016).

Perceptions of a good death vary substantially across cultures, reflecting divergent spiritual, familial, and social values. The GDI shows robust cross-cultural reliability and offers a quantitative foundation for culturally sensitive end-of-life care. These findings highlight the need for palliative care policies and communication models that integrate patients’ and families’ cultural definitions of dignity, acceptance, and relational closure.