Acute Medicine | Palliative care | Recognising the last months and days of life and verifying death

Recognising the last months and days of life and verifying death
Session overview
Description
This session offers a framework for recognising patients who are at risk of deterioration and who may die soon (last months of life) and also recognising when death is imminent (last days). The priorities for care of the dying person are discussed and the communication with patients and families needed at these times is explored.

This session was reviewed by Ed Neville and Richard Kitchen and last updated in March 2021.

Learning objectives
By the end of this session you will be able to:

• use the 'surprise question' to identify patients who may be approaching the end of their life
• identify some key communication issues for patients and their family/carers in the dying phase and when death is imminent
• list the five priorities for care of the dying patient
• list the clinical signs that verify that a patient has died

About 1% of the population dies each year. The death of a patient is something most doctors and nurses will experience during the course of their practice. Many will have a vivid recollection of the first patient in their care who died.

Some experienced practitioners will intuitively know when a patient's death is approaching. Often there may be subtle, almost unnoticeable signs that alert them to the fact that death is not far away

Yet despite this, it remains fundamentally difficult to predict when patients have reached the last months, weeks and days of life.