Planning for and principles of managing catastrophic terminal events in palliative care

Most deaths in palliative care will be expected, and even sudden deaths may not be distressing. Catastrophic terminal events (eg major bleeding, acute airway obstruction) are rare and occur suddenly, with death expected imminently; these events can sometimes cause significant distress to patients and their families and carers.

For patients at risk of a catastrophic terminal event, sensitively discuss and plan the care of a potential event, and create an advance care plan; seek advice from the patient’s palliative care team. Planning considerations include whether resuscitation or active management would be undertaken, who should be contacted (eg family, palliative care team, general practitioner, ambulance), and the role of sedation. For advice on planning to manage bleeding, see Planning for management of bleeding in palliative care.

Follow the principles of managing emergencies in palliative care when caring for patients experiencing a catastrophic event.

Remain with patients experiencing a catastrophic terminal event to provide psychological support and the comfort of a calm physical presence. This is more important than the use of a drug; there may be no time to access the drug, or for it to take effect.

For information on supporting families¹ and carers when patients are approaching death, see Loss, grief and bereavement.