Last 24 hours before death cancer
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End-of-Life Care in Terminal Cancer Patients: Insights from Recent Research
Diagnostic and Therapeutic Interventions in the Last 24 Hours
In the final 24 hours of life, many terminal cancer patients continue to receive diagnostic and therapeutic interventions, despite their questionable benefits. A study found that 24% of patients underwent diagnostic procedures, and 31% received therapeutic interventions during this period. On average, patients were administered 5.8 types of medication. Awareness of impending death by physicians significantly reduced the use of these interventions, suggesting that better recognition of the dying process could improve end-of-life care.
Physical and Medical Changes in the Dying Process
The physical signs of impending death in terminal cancer patients follow a common pathway. Key indicators include the onset of death rattle, respiration with mandibular movement (RMM), cyanosis on extremities, and pulselessness on the radial artery, with death typically occurring within hours of these signs. The ratio of patients who were awake, drowsy, or comatose shifted dramatically in the last 24 hours, with a significant increase in opioid use to manage pain and other symptoms.
Continuous Electrocardiographic Monitoring and Family Satisfaction
Continuous electrocardiographic monitoring (CEM) in the last 24 hours of life is generally not recommended. However, a study exploring family satisfaction found that while most families were content without CEM, a small proportion expressed dissatisfaction. Adequate explanations about the absence of CEM were crucial in maintaining family satisfaction and reducing psychological distress.
Opioid Use and Pain Management
Opioids are commonly used to manage pain in terminal cancer patients. Studies indicate that opioid administration does not negatively impact survival, making them a safe option for symptom relief in the last days of life. The use of opioids increases significantly as death approaches, with higher doses required for patients with certain metastases, such as spinal metastases. Effective pain management is crucial, as pain is significantly associated with a desire for hastened death among terminally ill patients.
Medications in the Last 24 Hours
The use of medications in the last 24 hours of life is critical for ensuring patient comfort. Commonly prescribed drugs include opioids, benzodiazepines, major tranquilizers, and antimuscarinic agents, which can be administered subcutaneously or intravenously. These medications help manage pain, restlessness, retained secretions, breathlessness, and nausea, which are prevalent symptoms in actively dying cancer patients.
Psychological Impact on Families
The awareness time of a spouse's impending death significantly affects the psychological well-being of the surviving partner. Short awareness times (24 hours or less) are associated with higher risks of anxiety and the use of tranquilizing drugs among widows. Providing timely information and psychological support can mitigate these adverse effects.
Conclusion
The last 24 hours of life for terminal cancer patients involve complex medical and emotional challenges. Reducing unnecessary interventions, managing symptoms effectively with appropriate medications, and providing psychological support to families are essential components of high-quality end-of-life care. Awareness and recognition of the dying process by healthcare providers can significantly improve the care and comfort of terminally ill patients.
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