In palliative care, avoid false hope ("It will get better"), unsolicited advice, comparisons ("My uncle had that..."), spiritual platitudes ("God has a plan"), minimizing feelings ("I know how you feel"), or saying "I don't know what to say," as these invalidate the person's experience; instead, offer presence, validate emotions with "That sounds hard," and focus on realistic comfort and support.
Avoid talking in an overly optimistic way, for example, “You'll be up in no time”. Such comments block the possibility of discussing how they're really feeling – their anger, fears, faith etc. Apologise if you think you've said the wrong thing. Let them know if you feel uncomfortable.
Three Magical Phrases To Comfort A Dying Person
The 7 Cs of Palliative Care are a framework for quality care, often centered around Communication, Coordination, Comfort, Continuity, Choice, Carer Support, and Closure, emphasizing holistic, patient-centered support throughout serious illness, not just at the end of life, by managing symptoms, respecting autonomy, and ensuring seamless care across settings. Different models exist, but these core principles focus on compassion, teamwork, and respecting the patient's values to improve quality of life.
Sudden death, terminal illness, organ failure, and frailty are the four most common types of illness trajectories found in end-of-life care.
What other signs might there be that death is near? One is 'terminal agitation' or restlessness. This often appears as a need to get out of bed, agitated behaviour or commonly plucking of the sheets or 'knitting' of the hands. They might reach out as if towards something or somebody.
Some proponents of the trifunctional hypothesis distinguish two types of threefold deaths in Indo-European myth and ritual. In the first type of threefold death, one person dies simultaneously in three ways. He dies by hanging (or strangulation or falling from a tree), wounding, and by drowning (or poison or burning).
A good death is the best death that can be achieved in the context of the individual's clinical diagnosis and symptoms, as well as the specific social, cultural and spiritual circumstances, taking into consideration patient and carer wishes and professional expertise.
Using an individualised approach, assess which medicines may be needed to manage symptoms likely to occur in the patient's last days of life (such as morphine for pain and breathlessness; midazolam for agitation; levomepromazine or haloperidol for nausea and vomiting and delirium; or hyoscine butylbromide for ...
Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease , cancer, dementia, Parkinson's disease, and many others.
Speak soothing words
Here are a few examples of phrases from this article from Renaissance Funeral Home and Crematory that mean the world to friends and family who are suffering an impending loss: “I love you, always.” “I'm here for you, no matter what.” “You're not alone; we're in this together.”
Key signs 2 weeks before death at the end-of-life stages timeline: Extreme fatigue and increased sleep. A marked decrease in appetite and fluid intake. Irregular breathing patterns (Cheyne-Stokes breathing)
Hospice Isn't About Giving Up
It's not a place to speed up the process of dying. A doctor suggesting hospice does not mean they're giving up on providing care and medical treatment. It's end-of-life care, but this doesn't mean giving up hope. It means shifting focus from curative treatments to comfort and support.
Preparing to Deliver Bad News
Determine who should be present. Ask the patient who they want to participate and clarify their relationships to the patient. Decide if you want others present (e.g. nurse, consultant, chaplain, social worker) and obtain patient/family permission.
It's hard to say goodbye – but you don't have to “say” anything. Most critical: Just show up. Be there. Foot rubs, stroking an arm or shoulder, kisses, smiles and gazing into someone's eyes all communicate compassion, love and gratitude for a shared lifetime.
Let them know you're listening
"It sounds like you're dealing with a lot at the moment" "I'm really sorry to hear that you're feeling like this right now" "I'm really glad you're sharing this with me"
Midazolam SC 10mg–20mg over 24 hours in a syringe pump + midazolam SC 2mg–5mg hourly as required. Levomepromazine may need to be used in addition to midazolam under specialist advice. Use lower doses if not used previously and in frail elderly for example: levomepromazine SC 2.5mg-5mg as required 2 hourly.
Under this guideline, at least 80% of all hospice care must be provided in a patient's home setting, such as a private residence, assisted living, or nursing facility. The remaining 20% may take place in inpatient hospice centers or hospitals for short-term pain control or caregiver relief.
Key points to remember. Morphine is very effective for pain management and is used for both adults and children. Children are commonly given morphine to relieve pain, which can help them continue to move about and have a better quality of life.
Palliative care duration is highly variable, lasting from a few months to several years, or even decades, depending on the illness, its progression, and the patient's needs; it starts at diagnosis (or any point in a serious illness) and continues as long as needed, even alongside curative treatments, and can include support for the family beyond death. It's designed to manage symptoms and improve quality of life for people with serious illnesses like cancer, heart, lung, or neurological diseases, and can transition to hospice care when life expectancy shortens to about six months.
Voluntary Stop Eating and Drinking (VSED)
Many people are unaware that stopping treatment can result in a peaceful death. For example, people on dialysis for kidney failure may be able to die peacefully by stopping dialysis. However, stopping medical treatments may increase discomfort or suffering.
Seriously ill patients encountered by hospice and palliative care clinicians are at risk for thirst due to dehydration, electrolyte disturbances, hypotension, xerostomia, and immobility which can impede access to water.
Physical signs of dying
Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing. Towards the end, dying people will often only breathe periodically, with an intake of breath followed by no breath for several seconds.
Objective To determine if functional decline differs among 4 types of illness trajectories: sudden death, cancer death, death from organ failure, and frailty.
The 3 C's of grief are Control, Connection, and Continuity - three fundamental psychological needs that become disrupted after loss and require intentional attention during the grieving process.