​Imminent Death and hospice

When a loved one is diagnosed with cancer, everyone knows that death is almost inevitable. Yet, most people are not comforted with the knowledge. Grief and bereavement begin in the immediate aftermath of this news, but grief and dignity must wait until a time when the body has begun to rest. Until that time, though, there are things we can do on our own and within ourselves to prepare ourselves for what to expect next.

In a recent study, the occurrence and frequency of 52 identified physical signs and their predictive functional outcome for impending death was studied. Five highly specific physical indications associated with death among cancer patients were studied. These included rapid pulse, heart palpitations, generalized sweating, diarrhea, abdominal pain and bloating. These symptoms were analyzed as a means of determining which clinical indicators might point to the imminent arrival of death in patients with cancer. The study specifically focused on the last 6 months before death and further analyzed the results according to specific sign category.

In an average case, patients have approximately one year to live. This is a general framework that can take into account other factors, including the existence of treatments and survival factors. However, when the prognosis for death is considered, it is necessary to ask what can we do as family members and friends to cope with the situation. How do I tell my children that their father or mother or grandparent is about to die?

When facing the reality of an impending death, families and friends often turn to hospice care for help. While hospice is not a direct treatment or preventative service, it can offer emotional, spiritual, and practical support to make sure that patients receive all the resources they need. In short, hospice is a non-medical solution to the end-of-life questions that many patients and families struggle with. Family members and friends are encouraged to seek assistance from hospice staff to make sure that patient care details are managed effectively.

As per hospice policy, family members and friends are prohibited from interfering in patient affairs unless they have specific permission from the patient's doctor. The primary purpose of this policy is to protect the dignity of patients and allow for the dignified and respectful communication between caregiver and patient. It also ensures that family members and friends are informed of a patient's actual condition and what they should expect upon their arrival at the end-of-life facility. Additionally, when approaching death, patients must be made aware of their options and have an opportunity to decide whether they want to pursue those options. If patients opt to withdraw from the hospice process, they must provide written notice to the hospice provider and, if withdrawal occurs, the hospice provider must inform the patient of their decision to comply with their wishes.

Another policy of hospice is to meticulously monitor the progress of patients who are approaching death and implementing necessary treatments. Providers must document all diagnostic signs. This documentation aids in determining when treatment is ineffective and helps in selecting appropriate courses of treatment. The first step is to document and age (medically insignificant or not discernable at an early time) the patient's age, weight, sex, vital signs, and response to diagnostic tests. Patients' vital signs such as blood pressure, heart rate, temperature, and respiration should be noted. Progress reports, which are documented in detail, should be obtained and reviewed on a regular basis, especially in case of deterioration or cessation of treatment.
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Patients must undergo imaging procedures such as electrocardiogram, ultrasound, CT scan, and MRI as part of their imaging protocol in case the patient is diagnosed with any disease or medical condition that affects the function of their lungs, heart, or brain. Patients may also be required to undergo additional diagnostic tests such as blood count, urine chemistry profile, bone density test, thyroid function test, and HIV and AIDs testing. If the patient is suffering from a decline in activities of daily living, such as bathing, walking, eating, and speaking, they may also need specialized care such as respiratory support, mechanical ventilation, assistance with bathing and dressing, mechanical traction, and mechanical assistive devices such as orthosis.
It is comforting to know that the staffs of hospice have taken time to research the literature related to a variety of topics that affect patients with diseases that threaten their lives. Patients who suffer from terminal illnesses can anticipate a better quality of life by engaging in activities that engage all the senses. Activities such as respite from pain and discomfort, increase in daily activities and functioning, and increase in quality of life can help patients with death threats to appreciate the end of their lives through the perspectives of dying. As well, hospice personnel have provided resources and information that have been useful to families of terminally ill loved ones in helping them deal with the inevitable.

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