The American journal of hospice & palliative care
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Am J Hosp Palliat Care · Jul 1998
A prospective study on the dying process in terminally ill cancer patients.
To determine the physical and medical change in the dying process, a prospective study was performed on 100 terminally ill cancer patients. The mean (median) time from the onset of death rattle, respiration with mandibular movement (RMM), cyanosis on extremities, and pulselessness on the radial artery to death was 57 (23) hours, 7.6 (2.5) hours, 5.1 (1.0) hours, and 2.6 (1.0) hours respectively. Death rattle preceded the other three conditions in 74 percent of the subjects, while RMM preceded cyanosis and pulselessness in 63 percent. ⋯ The number of opioid users and average dose increased significantly as death approached, from 42 percent and 49 mg/day (parental morphine equivalent) four weeks before death to 87 percent and 139 mg/day in the final 48 hours. The frequency of extra dosage also increased significantly, from 32 percent (opioid) and 40 percent (non-opioid) one week before death to 68 percent and 66 percent in the last 48 hours, respectively. The change of physical signs and medical intervention when death is impending has a common pathway in spite of large individual variations; thus, understanding this nature can help clinicians to offer better palliative care to terminal cancer patients.