end of life

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Epidemiology

  • hospice is increasingly used at the end of life
    • this trend has not necessarily made death a more peaceful experience for patients or their families
  • frenzied moves during the last months of life
  • most medical care & death still occurs in an institution rather than at home[9]
  • end-of-life decisions in minorities tend to be family-centered[17]
    • hispanics more so than whites believe that the family rather than the patient should be informed of prognosis & should make end-of-life decisions for patient[17]
    • hispanic adults often confer with several extended family members in end-of-life discussion, but final decisions are usually made by one family member[17]
  • hispanics tend to choose life-sustaining treatments rather than refuse them[17]
  • black patients were more likely to overestimate their life expectancy & elect intensive end-of-life medical intervention than white patients
  • black nursing home residents are hospitalized during the last 30 days of life more frequenly than white residents (43 vs 32%)
  • white nursing home residents are more likely than black residents to have do-not-hospitalize or do-not-resuscitate orders[34]
  • 1/3 of nursing home patients with atrial fibrillation continue to receive anticoagulation at the end-of-life[38]

Clinical manifestations

Management

Notes

No support for belief that cancer patients can delay their death for an important event.[2]

Spiritual & existential concerns of patients at end-of-life

  • past
    • value & meaning of person's life
    • worth of relationships
    • value of previous achievements
    • painful memories or shame
    • guilt about failures, unfulfilled aspirations
  • present
  • future
    • impending separation
    • hopelessness
    • meaninglessness
    • death
  • religion
    • strength of faith
    • a life lived without disgrace to the faith
    • existence of afterlife

More general terms

More specific terms

Additional terms

References

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