Care Strategy for Death Rattle in Terminally Ill Cancer Patients and Their Family Members: Recommendations From a Cross-Sectional Nationwide Survey of Bereaved Family Members' Perceptions

• Yoichi Shimizu, RN, MHlthSci
,
• Mitsunori Miyashita, RN, PhD
,
• Tatsuya Morita, MD, PhD
,
• Kazuki Sato, RN, PhD
,
• Satoru Tsuneto, MD, PhD
,
• Yasuo Shima, MD

Journal of Pain and Symptom Management
Volume 48, Issue 1 , Pages 2-12, July 2014

Abstract 

Context

Bereaved family members witnessing a patient's death rattle often experience distress. However, the benefits of specific care measures aimed at decreasing death rattle-associated family distress have not yet been evaluated.

Objectives

To clarify death rattle-related emotional distress levels among family members and their perceptions of the need for death rattle care improvement and explore the factors influencing both these issues.

Methods

A cross-sectional questionnaire survey of bereaved family members of cancer patients was conducted in 95 palliative care units in June 2007.

Results

Six hundred sixty-three questionnaires were mailed out, and 390 (61%) responses were analyzed. Among these, 181 (46%) respondents experienced death rattle. Of these, 66% reported high distress levels and 53% perceived a strong need for improved death rattle care. Factors influencing high distress levels were the gender (female) of family members, unawareness about death rattle being a natural phenomenon, and their fear and distressing interpretations of death rattle. Factors influencing perceptions of a strong need for improved care were the gender (male) of family members, severity of death rattle, death rattle-associated discomfort to patients, family members' experiences of inadequate nursing care (e.g., repositioning) and insufficient consultation about suctioning, and their perception of uncomfortable smells.

Conclusion

To decrease family-perceived distress, medical staff should alleviate patient symptoms and suffering with a comprehensive care strategy, try to decrease uncomfortable smells, and communicate with family members to address distressing interpretations and fears.

Key Words: Death rattle, respiratory sounds, neoplasm, terminal care