Only one chance to get it right: end of life care

When are the last days?

In this article we refer to the last few days of life, when the final decline on the background of a progressive illness has begun--this is not always easy to identify and others' perspectives must be added to it. Nursing staff have longer periods of direct patient contact and their impression should be noted. Families (in which we include all “significant others” and not only relatives) and, when lucid, patients may perceive signs of imminent death. They may have no special knowledge of dying but have a unique insight and their impressions often add sensitivity to the identification of end of life events. It is less difficult to predict end of life in patients with incurable cancer than in other patients. Some of the most important indicators that life is coming to end are:

• Progressive and profound weight loss

• Profound weakness

• Impaired cognition

• Reduced oral intake and difficulty in taking oral medication

Sometimes there is …