From the Guidelines
When a patient is receiving hospice care, clinical indicators of imminent death include progressive weakness, immobilization, loss of interest in eating and drinking, cognitive impairment, changes in breathing pattern, and existential suffering, as highlighted in the 2020 European Association for Palliative Care task force expert position statement 1. These indicators are crucial in identifying patients who are approaching the end of life, allowing healthcare providers to focus on comfort measures and palliative care.
Key Clinical Indicators
- Progressive weakness and immobilization
- Loss of interest in eating and drinking
- Cognitive impairment with diminishing verbal communication
- Changes in breathing pattern, such as moist breathing or a 'death rattle'
- Existential suffering
Palliative Care Interventions
Palliative care interventions, as outlined in Table 3 of the study 1, play a vital role in supporting patients with heart failure, including:
- Advance care planning (ACP) to address disease-specific aspects and patient preferences
- Addressing ethical dilemmas that may arise during care
- Spiritual care to address religious needs and existential quests
- Adjusting medical therapy to prioritize comfort and minimize harm
- Care for the dying, including diagnosing dying, caring for the dying, and communicating with patients and their families
Comfort Measures
Healthcare providers can offer guidance on comfort measures, such as medication management for pain or anxiety, and emotional support during this difficult transition. It is essential to discontinue or not initiate interventions that do not contribute to the aim of preserving the highest level of comfort, as emphasized in the study 1. By recognizing these clinical indicators and providing appropriate palliative care, healthcare providers can improve the quality of life for patients receiving hospice care and support them through the end-of-life transition.
From the Research
Clinical Indicators of Imminent Death
The clinical indicators of imminent death in a patient receiving hospice care include:
- Diminished daily living performance
- Decreased food intake
- Changes in consciousness and increased sleep quantity
- Worsening of respiratory distress
- End-stage delirium 2 Other symptoms that may be present in patients at the end of life include:
- Anorexia
- Fatigue
- Drowsiness
- Decreased well-being
- Pain 3
Assessment Tools
Assessment tools such as the Edmonton Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS) can be used to evaluate symptom distress and delirium in patients at the end of life 3. The Nursing Delirium Screening Scale (Nu-DESC) may not be a reliable tool for screening delirium when scoring is conducted by a caregiver 3.
Importance of Early Identification and Communication
Early identification and recognition of end-of-life care choices can heavily influence the quality of life an individual experiences during the dying process 4. Communication between the multidisciplinary hospice team, patients, and families is crucial in providing consistent explanations and support 2. Inadequate communication can be a significant barrier in coordinating and providing end-of-life care 4.