From the Guidelines
Cause of Increased Groaning in Hospice Patients
The most likely cause of increased groaning in a hospice patient is delirium, which can masquerade as pain and vice versa, leading to caregiver misinterpretation 1.
- Delirium rather than pain may cause a dying patient to groan when stimulated, highlighting the need for a thorough assessment to differentiate between the two 1.
- Other potential causes of groaning include pain, constipation, urinary retention, and treatable emotional disorders such as major depression, which should be evaluated and addressed accordingly 1.
- A mental health professional consultation may be necessary to assess for underlying emotional disorders that could be contributing to the patient's distress 1.
- It is essential to consider palliative care consultation to ensure the patient has received all appropriate elements of traditional palliative care and to assess for any intractable suffering 1.
- In some cases, palliative sedation may be considered, but this should be discussed fully with the patient or surrogate and patient’s family to ensure informed consent 1.
From the Research
Possible Causes of Increased Groaning in Hospice Patients
- Pain: Studies have shown that pain is a common symptom in hospice patients and can contribute to restlessness and discomfort 2
- Constipation: Opioid-induced constipation is a common issue in hospice patients, which can cause significant discomfort and lead to groaning 3
- Dyspnea: Shortness of breath can also contribute to restlessness and groaning in hospice patients 2
- Anxiety and agitation: End-stage restlessness, or terminal agitation, is characterized by physical, emotional, or spiritual distress, agitation, or anxiety, which can cause groaning 2
Factors Associated with Groaning in Hospice Patients
- Ethnicity: Being Hispanic/Latino has been shown to be a risk factor for experiencing end-stage restlessness, which can include groaning 2
- Palliative sedation treatment: Receiving palliative sedation treatment has also been associated with an increased risk of end-stage restlessness and groaning 2
Management of Groaning in Hospice Patients
- Pharmacologic treatments: Various medications, such as laxatives and stool softeners, can be used to manage constipation and other symptoms that may contribute to groaning 3
- Nonpharmacological approaches: Recreation therapy and other holistic approaches can be used to target cognitive, social, emotional, and physical domains of patient care and increase overall well-being 4