Overview of care in the last days of life

Australian Commission on Safety and Quality in Health Care (ACSQHC), 2015National Institute for Health and Care Excellence (NICE), 2015Tait, 2014

Care in the last days of life is multifaceted and aims to maintain patient comfort. Optimal care for the last days of life involves:

• recognising when death is approaching to allow the patient and their family¹ and carer(s) to prepare, and the healthcare team to plan care—see Preparing for the last days of life
• ensuring that management is consistent with the patient’s preferences, including location of care and death
• communicating with the patient, family, carers and relevant healthcare professionals to ensure all know the patient is dying and all understand the goals of care
• monitoring the patient to ensure they are comfortable and their symptoms are managed with nonpharmacological measures and, if indicated, drug therapy
• rationalising treatments to avoid unnecessary and nonbeneficial interventions—see Decisions about withdrawing or withholding treatment in palliative care
• providing practical, emotional and psychological support to the patient and their family and carer(s).

Most patients are unconscious in the last days of life. As patients become less responsive, verbal communication becomes more difficult. Although patients may appear to be unconscious or semiconscious, they may be aware of what is going on around them. Talk to patients about the care you are providing; this can be done at the same time as telling the family and carers. Be conscious of the conversations you are having near a patient’s bedside. Consider moving away to have sensitive conversations that you would not have in earshot of the patient if they were awake.

For management of catastrophic terminal events, see Catastrophic terminal events in palliative care.

For management after a patient has died, see After-death care.