The American journal of hospice & palliative care
-
Dyspnea is a complex subjective experience that is common in terminal illness. Patients may present at any time during the course of their illness, although prevalence increases with disease progression. ⋯ The main pharmacological palliative treatments are oxygen, opioids, and benzodiazepines, but the evidence to support these treatments is limited. More research is urgently needed to establish the efficacy of current treatments and to identify new ones.
-
Health practitioners face many challenges when caring for and communicating with dying persons. As truth-tellers, we search for ways to communicate with honesty, sensitivity, and compassion. Creative use of language is one aspect of caring. ⋯ It allows us to share a truth without the glare of reality. This author contends that metaphor is mysterious, creative, invitational, safe, open to interpretation, respectful and playful. The creative and judicious use of metaphor provides health care practitioners with many veils--veils that shield the dying from the glare of their prognosis, veils particularly valuable and suited in communicating with our palliative patient population.
-
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.