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End-of-Life Essentials Blog

Our blog shares information, tips and ideas for health professionals on the delivery of quality end-of-life care in hospitals.

Recognising When End of Life is Near: 4 Key Signs

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Anna Nicholas, a palliative care Clinical Nurse Consultant at the Royal Hobart Hospital, has been leading the rollout of a statewide plan to improve end-of-life care in Tasmania. In a recent webinar by Palliative Care Tasmania, Anna shared her insights from her experience in nursing and end-of-life care.

How do we recognise when individuals are approaching the end of life? This is a question often asked, especially in clinical settings.

Here are 4 key indicators that may signal this transition.

1. Consider functionality.

Patients experiencing a significant decline in their ability to carry out activities of daily living, spending more time bedridden, or struggling to maintain their own self-care tasks may be showing signs of deterioration. Rapid declines in functional ability often correlate with poor prognoses, particularly in those with non-malignant diseases where the trajectory can be more complex.

2. Investigations play a crucial role.

Depending on the underlying disease process, certain markers may become relevant. For instance, elevated calcium levels in advanced cancer patients or declining renal function indicated by changes in creatinine and estimated glomerular filtration rate (EGFR) are significant indicators of decline.

3. Prognostication.

This involves assessing the overall prognosis of the illness and the trajectory of the patient. Understanding how certain conditions, such as heart failure or metastatic cancer, typically can provide valuable insights into a patient's likely trajectory and outcome.

4. Physical examination offers invaluable insights.

Changes such as reduced oral intake, increased drowsiness, altered breathing patterns, incontinence, changes in skin colour and temperature, as well as fluctuations in blood pressure and heart rate, can all signal the transition towards the end of life.

These signs are particularly prevalent in individuals with advanced illnesses such as heart failure, respiratory failure, or advanced cancers, and often indicate a poor prognosis.

Recognising these indicators and understanding their implications is crucial for providing appropriate care, communication, and support to individuals and their families during this challenging time.

Learn more in Recognising the End of Life, from the End-of-Life Essentials Orientation to End-of-Life Care education modules.

 

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