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Patients with advanced lung cancer can experience burdensome symptoms at the end of life. Pulmonologists can alleviate some of this.
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The ability to accurately diagnose impending death in patients would be beneficial to clinicians, patients and their families.Diagnosis of an impending death can help clinicians, patients and their friends and family to make important decisions. Doctors can spare time and resources by stopping daily bloodwork and medication that will not make a short-term difference.
Families will know if they still have time to visit their relatives.“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life,” says study author Dr. David Hui.“Upon further confirmation of the usefulness of these ‘tell-tale’ signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life.”The study, published in Cancer, follows on from the Investigating the Process of Dying Study – a longitudinal observational study that documented the clinical signs of patients admitted to an acute palliative care unit (APCU).
During the study, the researchers identified five signs that were highly predictive of an impending death within 3 days.For the new study, the researchers again observed the physical changes in patients admitted to two APCUs – at the MD Anderson Cancer Center in Houston, TX, and the Barretos Cancer Hospital in Brazil. A total of 357 cancer patients participated in the study. The researchers observed them and documented 52 physical signs every 12 hours following their admission to the APCUs.
The patients were observed until they died or were discharged from the hospitals, with 57% dying during the study.The researchers found eight highly-specific physical signs identifiable at the bedside that strongly suggested that a patient would die within the following 3 days if they were present. The signs identified were:. Decreased response to verbal stimuli. Decreased response to visual stimuli. Drooping of “smile lines”. Grunting of vocal cords.
Hyperextension of neck. Inability to close eyelids.
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Non-reactive pupils. Upper gastrointestinal bleeding.With the exception of upper gastrointestinal bleeding, all of these signs are related to deterioration in neurocognitive and neuromuscular function. “The high specificity suggests that few patients who did not die within 3 days were observed to have these signs,” the authors write.
“These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process.”As the study is limited by only examining cancer patients admitted to APCUs, it is not known whether these findings will apply to patients with different types of illness.
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