Dying as a 'normal', 'ordinary' or 'natural' process in palliative care: a systematic scoping review and narrative...

The World Health Organization definition of palliative care describes dying as a 'normal' process and it, along with related ideas of 'ordinary' or 'natural' dying, is important in understanding what a 'good' death is. This scoping review aims to explore how dying has been described as 'normal', 'ordinary' or 'natural' in empirical palliative care literature to provide palliative care stakeholders with evidence-based insights into how this concept may enable quality dying experiences and a 'good' death.

A scoping review was conducted by searching six online databases (Medline (via Ovid), Embase (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Web of Science, and Scopus) for empirical English-language palliative care literature that explicitly described dying as 'normal', 'ordinary', 'natural', or their interchangeable terms 'standard, 'typical' or 'usual'. A narrative synthesis was used to present the clusters of features associated with their descriptions.

Twenty-one studies used 'normal', 'ordinary', 'natural' and 'typical' dying. They were often employed as a single statement despite some authors' concerns regarding the lack of conceptual clarity. Interchangeability between 'normal' and 'natural' dying was observed. Understandings of 'normal', 'natural' and 'typical' were found to be diverse, subjective, and contextually bounded. Although there was some evidence that 'normal', 'natural' and 'typical' dying can influence the quality of dying experiences in palliative care, there was no evidence for 'ordinary' dying due to a lack of explicit use in the included studies.

Understandings of dying as 'normal', 'natural' or 'typical' are held by clinicians and patients to play an important role in shaping the quality of dying experiences and providing a 'good' death in palliative care. However, the use of each idea remains heterogeneous, with conflicting definitions across terms. The diffuse evidence base suggests that the potential benefits, harms or limitations of their use in palliative care are therefore unclear. For this reason, we recommend caution regarding their use in practice or policy.