Last Days of Life–Health Professional Version (PDQ®)

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Changes to This Summary (04/08/2016)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Care Decisions in the Final Weeks, Days, and Hours of Life

Added text to state that patients who preferred to die at home were more likely to do so (56% vs. 37%; odds ratio [OR], 2.21).

Added text to state that patients were less likely to die at home (OR, <1) if there was moderate or severe pain (43% vs. 69%; OR, 0.56) or higher functional status as measured by the Palliative Performance Scale (OR, 0.53).

Forgoing Potentially Life-Sustaining Treatments

Revised text to state that a significant proportion of patients die within 14 days of transfusion, which raises the possibility that transfusions may be harmful or that transfusions were inappropriately given to dying patients.

Dying in the Hospital or Intensive Care Unit

Added text to state that it has been suggested that clinicians may encourage no escalation of care because of concerns that the intensive medical treatments will prevent death, and therefore the patient will have missed the “opportunity to die” (cited Cochrane as reference 1).

Added text to state that the patient or surrogates may choose to withdraw all life-sustaining treatment if there is no improvement during the limited trial. Also added text to state that from an ethical standpoint, withdrawing treatment is equivalent to withholding such treatment, and both actions are justified for unwarranted or unwanted intensive care.

The Dying Person and Intractable Suffering

Revised text to state that if the clinician anticipates that a distressing symptom will improve with time, then the clinician should discuss with the patient any recommendations about a deliberate reduction in the depth of sedation to assess whether the symptoms persist. Also added text to state that deliberate reductions in the depth of sedation may be appropriate if there is a desire for communication with loved ones.

This summary is written and maintained by the PDQ Supportive and Palliative Care Editorial Board, which is editorially independent of NCI. The summary reflects an independent review of the literature and does not represent a policy statement of NCI or NIH. More information about summary policies and the role of the PDQ Editorial Boards in maintaining the PDQ summaries can be found on the About This PDQ Summary and PDQ® - NCI's Comprehensive Cancer Database pages.

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