 |
Additional Information
|
|
The time at the end of life is different for each person.
Each individual has unique needs for information and support.
The patient's and family's questions and concerns about the
end of life should be discussed with the health care team
as they arise.
The following information can help answer some of the questions
that many patients, their family members, and caregivers
have about the end of life.
- How long is the patient expected to live?
Patients and their family members often want to know
how long a person is expected to live. This is a hard
question to answer. Factors such as where the cancer
is located and whether the patient has other illnesses
can affect what will happen. Although doctors may be
able to make an estimate based on what they know about
the patient, they might be hesitant to do so. Doctors
may be concerned about over- or under-estimating the
patient's life span. They also might be fearful of
instilling false hope or destroying a person's hope.
- When caring for the patient at home, when should the
caregiver call for professional help?
When caring
for a patient at home, there may be times when the caregiver
needs assistance from the patient's health care team. A
caregiver can contact the patient's doctor or nurse for
help in any of the following situations:
- The patient is in pain that is not relieved by
the prescribed dose of
pain medication;
- The patient shows discomfort, such as grimacing
or moaning;
- The patient is having trouble breathing and seems
upset;
- The patient is unable to urinate or empty the bowels;
- The patient has fallen;
- The patient is very depressed or talking about
committing suicide;
- The caregiver has difficulty giving medication
to the patient;
- The caregiver is overwhelmed by caring for the
patient, or is too grieved or afraid to be with the
patient; or
- At any time the caregiver does not know how to
handle a situation.
- What are some ways that caregivers can provide emotional
comfort to the patient?
Everyone has different needs, but some emotions are
common to most dying patients. These include fear of
abandonment and fear of being a burden. They also have
concerns about loss of dignity and loss of control. Some
ways caregivers can provide comfort are as follows:
- Keep the person company—talk, watch movies,
read, or just be with the person.
- Allow the person to express fears and concerns
about dying, such as leaving family and friends behind.
Be prepared to listen.
- Be willing to reminisce about the person's life.
- Avoid withholding difficult information. Most patients
prefer to be included in discussions about issues
that concern them.
- Reassure the patient that you will honor advance
directives, such as living wills.
- Ask if there is anything you can do.
- Respect the person's need for privacy.
- What are the signs that death is approaching? What can
the caregiver do to make the patient comfortable?
Certain signs and symptoms can help a caregiver anticipate
when death is near. They are described below, along with
suggestions for managing them. It is important to remember
that not every patient experiences each of the signs
and symptoms. In addition, the presence of one or more
of these symptoms does not necessarily indicate that
the patient is close to death. A member of the patient's
health care team can give family members and caregivers
more information about what to expect.
- Drowsiness, increased sleep,
and/or unresponsiveness (caused by changes in the
patient's metabolism).
The caregiver and family members can plan visits
and activities for times when the patient is
alert. It is important to speak directly to the
patient and talk as if the person can hear, even
if there is no response.
Most patients are still able to hear after they
are no longer able to speak. Patients should
not be shaken if they do not respond.
- Confusion about time, place, and/or
identity of loved ones; restlessness; visions of
people and places that are not present; pulling at
bed linens or clothing (caused in part by changes
in the patient's metabolism). Gently remind the patient
of the time, date, and people who are with them.
If the patient is agitated, do not attempt to restrain
the patient. Be calm and reassuring. Speaking calmly
may help to re-orient the patient.
- Decreased need for food and
fluids,
and loss of appetite (caused by the body's need to
conserve energy and its decreasing ability to use
food and fluids properly).
Allow the patient to choose if and when to eat
or drink. Ice chips, water, or juice may be refreshing
if the patient can swallow. Keep the patient's
mouth and lips moist with products such as glycerin
swabs and lip balm.
- Loss of bladder or
bowel control (caused by the relaxing
of muscles in the pelvic area).
Keep the patient as clean, dry, and comfortable
as possible. Place disposable pads on the bed beneath
the patient and remove them when they become soiled.
- Darkened urine or
decreased amount of urine (caused by slowing
of kidney function and/or decreased fluid intake).
Caregivers can consult a member of the patient's
health care team about the need to insert a
catheter to
avoid blockage. A member of the health care team
can teach the caregiver how to take care of the
catheter if one is needed.
- Skin becomes cool to the touch,
particularly the hands and feet; skin may become
bluish in color, especially on the underside of the
body (caused by decreased circulation to the extremities).
Blankets can be used to warm the patient. Although
the skin may be cool, patients are usually not
aware of feeling cold. Caregivers should avoid
warming the patient with electric blankets or heating
pads, which can cause burns.
- Rattling or gurgling sounds while
breathing, which may be loud; breathing that
is irregular and shallow; decreased number
of breaths per minute; breathing that alternates
between rapid and slow (caused by congestion
from decreased fluid consumption, a buildup
of waste products in the body, and/or a decrease
in circulation to the organs).
Breathing may be easier if the patient's
body is turned to the side and pillows
are placed beneath the head and behind
the back. Although labored breathing can
sound very distressing to the caregiver,
gurgling and rattling sounds do not cause
discomfort to the patient. An external
source of oxygen may benefit some patients.
If the patient is able to swallow, ice
chips also may help. In addition, a cool
mist humidifier may
help make the patient's breathing more comfortable.
- Turning the head toward a light source (caused
by decreasing vision).
Leave soft, indirect lights on in the room.
- Increased difficulty controlling pain (caused
by progression of
the disease).
It is important to provide pain medications
as the patient's doctor has prescribed.
The caregiver should contact the doctor
if the prescribed dose does not seem
adequate. With the help of the health
care team, caregivers can also explore
methods such as massage and relaxation
techniques to help with pain.
- Involuntary movements (called myoclonus),
changes in heart rate, and loss of reflexes in
the legs and arms are additional signs
that the end of life is near.
- What are the signs that the patient has died?
- There is no breathing or pulse.
- The eyes do not move or blink, and the pupils are
dilated (enlarged). The eyelids may be slightly open.
- The jaw is relaxed and the mouth is slightly open.
- The body releases the bowel and bladder contents.
- The patient does not respond to being touched or
spoken to.
- What needs to be done after the patient has died?
After the patient has passed away, there is no need
to hurry with arrangements. Family members and caregivers
may wish to sit with the patient, talk, or pray. When
the family is ready, the following steps can be taken.
- Place the body on its back with one pillow under
the head. If necessary, caregivers or family members
may wish to put the patient's dentures or other artificial
parts in place.
- If the patient is in a hospice program, follow
the guidelines provided by the program. A caregiver
or family member can request a hospice nurse to verify
the patient's death.
- Contact the appropriate authorities in accordance
with local regulations. If the patient has requested
not to be resuscitated through a Do-Not-Resuscitate
(DNR) order or other mechanism, do not call 911.
- Contact the patient's doctor and funeral home.
- When the patient's family is ready, call other
family members, friends, and clergy.
- Provide or obtain emotional support for family
members and friends to cope with their loss.
To read the rest of this article from the National Cancer
Institute, please click here: http://www.cancer.gov/cancertopics/factsheet/support/end-of-life-care
|
Additional
Information