Key Points for This Section

Knowing what to expect in the final days or hours may be comforting to the family. Patients often lose the desire to eat or drink in the final days or hours. Patients near death may not respond to others. A number of physical changes are common when the patient is near death. Patients and their families may have cultural or religious beliefs and customs that are important at the time of death.

Knowing what to expect in the final days or hours may be comforting to the family.

Most people are not familiar with the signs that death is near. Knowing what to expect can prepare them for the death of their loved one and make this time less stressful and confusing. Health care providers can give family members information about the changes they may see in their loved one in the final hours and how they may help their loved one through it.

Patients often lose the desire to eat or drink in the final days or hours.

In the final days to hours of life, patients often lose the desire to eat or drink, and may refuse food and fluids that are offered to them. The family may give ice chips or swab the mouth and lips to keep them moist. Forcing food and fluids can make the patient uncomfortable or cause choking. Family members may find other ways to show their love for the patient, such as massage.

Patients near death may not respond to others.

Patients may withdraw and spend more time sleeping. They may answer questions slowly or not at all, seem confused, and show little interest in their surroundings. Most patients are still able to hear after they are no longer able to speak. It may give some comfort if family members continue to touch and talk to the patient, even if the patient does not respond.

A number of physical changes are common when the patient is near death.

Some of the following physical changes may occur in the patient at the end of life:

• The patient may feel tired or weak.
• The patient may pass less urine and it may be dark in color.
• The patient’s hands and feet may become blotchy, cold, or blue. Caregivers can use blankets to keep the patient warm. Electric blankets or heating pads should not be used.
• The heart rate may go up or down and become irregular.
• Blood pressure usually goes down.
• Breathing may become irregular, with very shallow breathing, short periods of not breathing, or deep, rapid breathing.

Patients and their families may have cultural or religious beliefs and customs that are important at the time of death.

After the patient dies, family members and caregivers may wish to stay with the patient a while. There may be certain customs or rituals that are important to the patient and family at this time. These might include rituals for coping with death, handling the patient's body, making final arrangements for the body, and honoring the death. The patient and family members should let the health care team know about any customs or rituals they want performed after the patient's death.

Health care providers, hospice staff, social workers, or spiritual leaders can explain the steps that need to be taken once death has occurred, including contacting a funeral home.

(See the PDQ summary on Spirituality in Cancer Care ¹ for more information.)

Glossary Terms

The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).

A mental state in which one is not thinking clearly.

Liquid.

A program that provides special care for people who are near the end of life and for their families, either at home, in freestanding facilities, or within hospitals.

A treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Massage therapy may help people relax, relieve stress and pain, lower blood pressure, and improve circulation. It is being studied in the treatment of cancer symptoms such as lack of energy, pain, swelling, and depression.

PDQ is an online database developed and maintained by the National Cancer Institute. Designed to make the most current, credible, and accurate cancer information available to health professionals and the public, PDQ contains peer-reviewed summaries on cancer treatment, screening, prevention, genetics, complementary and alternative medicine, and supportive care; a registry of cancer clinical trials from around the world; and directories of physicians, professionals who provide genetics services, and organizations that provide cancer care. Most of this information, and more specific information about PDQ, can be found on the NCI's Web site at http://www.cancer.gov/cancertopics/pdq. Also called Physician Data Query.

In medicine, a repeated action (such as hand washing) done to relieve feelings of fear, dread, and uneasiness. This is often seen in people who have an obsessive-compulsive disorder.

A professional trained to talk with people and their families about emotional or physical needs, and to find them support services.

Having to do with deep, often religious, feelings and beliefs, including a person’s sense of peace, purpose, connection to others, and beliefs about the meaning of life.

Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.