From the Guidelines
A patient who is dying and somewhat responsive should be prioritized for comfort and symptom management, focusing on therapies of proven effectiveness to manage pain, dyspnea, and depression, as recommended by the American College of Physicians 1. To determine if a patient is getting relief from pain or terminal rest, healthcare providers should look for nonverbal cues such as facial grimacing, moaning, restlessness, or increased respiratory rate. Some key points to consider in managing a dying patient's symptoms include:
- Using therapies of proven effectiveness to manage pain, such as nonsteroidal anti-inflammatory drugs, opioids, and bisphosphonates, as recommended for patients with cancer 1
- Managing dyspnea with opioids in patients with unrelieved dyspnea and oxygen for short-term relief of hypoxemia 1
- Using therapies of proven effectiveness to manage depression, such as tricyclic antidepressants, selective serotonin reuptake inhibitors, or psychosocial intervention, for patients with cancer 1
- Ensuring advance care planning, including completion of advance directives, for all patients with serious illness 1 Regular assessment using tools designed for non-verbal patients helps guide appropriate medication adjustments, with the goal of care shifting to ensuring comfort rather than responsiveness. Family members should be educated about the normal dying process and reassured that appropriate comfort measures are being provided, even when the patient appears unresponsive. Medication dosing should be focused on symptom relief rather than consciousness level, prioritizing the patient's comfort and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Determining Response in Dying Patients
- The question of whether a patient who is dying is somewhat responding and getting out of pain or terminal rest is complex and multifaceted.
- Studies have shown that palliative care, including the use of medications such as morphine and midazolam, can help alleviate symptoms such as dyspnea and pain in terminally ill patients 2, 3, 4.
- The goal of palliative care is to relieve the suffering of patients and their families by comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms experienced by patients 5.
Assessing Patient Response
- Assessing whether a patient is responding to treatment can be challenging, especially in the terminal stages of illness.
- Studies have used various evaluation tools to assess dyspnea and pain in patients, including self-reporting and non-self-reporting tools 4.
- The use of opioids, such as morphine, can be effective in relieving dyspnea and pain, but can also have adverse effects such as sedation 2, 3, 4.
Managing Pain and Dyspnea
- Managing pain and dyspnea in dying patients requires a comprehensive approach that takes into account the patient's physical, psychosocial, and spiritual needs 5, 6.
- The use of medications such as corticosteroids, antidepressants, and anticonvulsants can also help alleviate pain and other symptoms 6.
- A team approach to care, including home visits, can provide comfort and facilitate the doctor-patient relationship at the end of life 6.