Letters to the Editor

Recognizing Patients' Transitions Toward the End of Their Life



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Am Fam Physician. 2010 Feb 15;81(4):401-406.

Original Article: Pharmacologic Pearls for End-of-Life Care

Issue Date: June 15, 2009

Available at: http://www.aafp.org/afp/2009/0615/p1059.html

to the editor: We commend the authors of this article for their comprehensive review of palliative pharmacologic interventions to relieve distressing symptoms as patients reach the end of their life. It was heartening that the authors advocated for hospice support for the patient and his or her family, as well as an understanding that a patient's preferences and goals should direct the care.

There is sometimes a gradual shift in interventions as a patient moves from curative treatments to palliative care. However, there is little or no training in how to recognize when a patient has begun the dying process. There is rarely a clear demarcation between the stages of living with and dying from a chronic disease. When entering the dying process during the last three to six months of their life, all patients act the same regardless of what organ system is failing. They go from eating, to tasting, to just looking at food. There is often a reversal of the sleep-wake cycle. There is a decline in functional ability, with the patient needing more assistance with activities of daily living and instrumental activities of daily living. There is also an increase in caregiver stress.

We identified a knowledge deficit in our medical community and created a booklet and presentation to help doctors recognize the indicators that identify a dying patient. These indicators and other useful tools are available on the Hospice of Marion County's Web site: http://www.hospiceofmarion.com/physicians.html.

Author disclosure: Nothing to disclose.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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