Diagnosing dying in cancer patients

Posted on January 21, 2014 by pallcare

Franzisca Domeisen Benedetti, Sociologist and Research Assistant, Centre for Palliative Care, Cantonal Hospital St Gallen, Switzerland, explains the background to a systematic literature review about the signs and symptoms of people close to death published in the November/December issue of the European Journal of Palliative Care. 

Franzisca Domeisen Benedetti

A key area to address in palliative care is recognition or ‘diagnosis’ that a patient is dying. But clinically assessing the point at which a patient enters this last phase of life is a challenge for each clinician.

Within the European Union project, OPCARE9 (2008-2011), our work package 1 was tasked to look into the complex topic of ‘signs and symptoms of approaching death’. 

We therefore conducted an expert discussion (using Delphi technique) and a literature review. The goal of our literature review was to provide an overview of the evidence supporting the timely recognition of the entry into the dying phase in patients with cancer. The difficulty of reviewing the literature was to find those studies that really were dying-specific, meaning concerned with the last hours and days of life. Many more studies focused on the last weeks and months of life. This was surprising compared to the frequency of such situations in which health care professionals are engaged. In our daily practice we also recognised that a lack of knowledge and discussion about the dying process may cause uncertainty and may lead to suboptimal care.

This literature review encouraged us to plan and actually conduct research in this area, to give more evidence to this topic. Participants (healthcare professionals) share an interest in improving knowledge and skills to better forecast that someone will die within the next days. Their intention is to achieve better communication and to reduce the harm caused by ‘over diagnosis and treatment’ in the last days of life.