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Palliative cancer care - general issues - Management
How should I recognize the terminal phase?
- It is essential to recognize the signs of dying in order to appropriately care for people at the end of life.
- People are likely to be in the terminal phase of their illness when they:
- Deteriorate day by day or faster because of their underlying condition.
- Express a realization that they are dying.
- Have reduced cognition, and are drowsy or comatose.
- Are bed-bound.
- Take little food or fluid, and have difficulty taking oral medication.
- Are peripherally cyanosed and cold.
- Have an altered breathing pattern.
- For further information, see the Prognostic Indicator Guidance (pdf), which is part of the Gold Standards Framework.
Clarification / Additional information
- The terminal phase starts a median of 23 hours before death and may last hours to several days [Morita et al, 1998].
- It is important to recognize the terminal phase so that appropriate management pathways, such as the Liverpool Care Pathway (which offers a framework for caring for people at the end of life), can be utilized. For further information, see www.mcpcil.org.uk/liverpool-care-pathway.
Basis for recommendation
- This recommendation is based on expert opinion from palliative care resources that were developed from clinical experience [Regnard and Hockley, 2004].
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