• Catriona Kennedy, Patricia Brooks-Young, Carol Brunton Gray, Phil Larkin, Michael Connolly, Bodil Wilde-Larsson, Maria Larsson, Tracy Smith, and Susie Chater.
• Department of Nursing and Midwifery, University of Limerick, Edinburgh Napier University, Limerick, Ireland.
• BMJ Support Palliat Care. 2014 Sep 1; 4 (3): 263-70.

BackgroundTo ensure patients and families receive appropriate end-of-life care pathways and guidelines aim to inform clinical decision making. Ensuring appropriate outcomes through the use of these decision aids is dependent on timely use. Diagnosing dying is a complex clinical decision, and most of the available practice checklists relate to cancer. There is a need to review evidence to establish diagnostic indicators that death is imminent on the basis of need rather than a cancer diagnosis.AimTo examine the evidence as to how patients are judged by clinicians as being in the final hours or days of life.DesignIntegrative literature review.Data SourcesFive electronic databases (2001-2011): Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. The search yielded a total of 576 hits, 331 titles and abstracts were screened, 42 papers were retrieved and reviewed and 23 articles were included.ResultsAnalysis reveals an overarching theme of uncertainty in diagnosing dying and two subthemes: (1) 'characteristics of dying' involve dying trajectories that incorporate physical, social, spiritual and psychological decline towards death; (2) 'treatment orientation' where decision making related to diagnosing dying may remain focused towards biomedical interventions rather than systematic planning for end-of-life care.ConclusionsThe findings of this review support the explicit recognition of 'uncertainty in diagnosing dying' and the need to work with and within this concept. Clinical decision making needs to allow for recovery where that potential exists, but equally there is the need to avoid futile interventions.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

6 keywords...

hide…