Caring for someone in their last days and hours

Please be aware - this information is for healthcare professionals

While it may be difficult to talk about, dying is a normal part of life. Talking to your patient about the end of life requires both honesty and sensitivity. 

While it’s vital to have open and honest conversations with patients and any family or friends, it’s equally important to avoid pushing the subject. You may want to wait until they indicate that they’re ready to discuss issues around dying, and allow them to lead the conversation.

Just as no two people are the same, no two deaths are the same. So it’s important to continue providing person-centred care. This means taking active steps to understand the person’s current and anticipated care needs, including their preferences for symptom management and personal goals and wishes.

Remember that any conversations about preferences for care should be documented in the advance care plan, so that everyone is as prepared as possible, and the patient’s wishes can be respected.

It’s also important to remain mindful of any cultural, religious, social or spiritual issues. 

Caring for someone who is dying may feel daunting at times. But by remaining calm and practising coordinated team working, this may take some of the pressure off and help you provide a higher quality of care.

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How do I approach talking to a patient at the end of their life?

Try handling difficult conversations by using a reflective style of communication. This means asking the person about what’s on their mind and taking the time to listen to what they say. Remember to allow the person to lead the conversation and wait to be prompted before asking them about any concerns or worries they have – don’t assume you know what they want to talk about.

Try and confirm your understanding before responding to what they are saying. Be gentle, empathise and be honest. If you can’t meet the patient’s wishes, take the time to explain why.

It’s also important to think about body language. For example, touch can be helpful and in some situations, simply holding the person’s hand or giving them a hug may be the best way to give reassurance. Remember to gain consent if possible before touching someone, as it may not be personally or culturally appropriate. For more detail, see our information about talking to someone affected by a terminal illness.

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How do I approach talking to the patient’s family and loved ones?

Try to talk openly about what is happening in a calm and relaxed manner.

If you are open, honest and straightforward, this should make it easier for them to ask questions and share any worries or concerns.

Family or friends may be able to help you understand the person’s needs and wishes. Or sometimes there may be some tension or conflict between the patient’s needs and what their loved ones want. In these instances you should act as the patient’s advocate, if they want you to. If you have any concerns, speak to other professionals involved in the person’s care for advice and support.

The person’s family or friends may find some end of life symptoms distressing, so you need to consider how you can support them too. For example, you may be able to suggest ways they can be involved in their loved one’s care in the last days or hours. For more, see our information on talking to carers, family and friends and carers.

You may find it helpful to share our information on preparing for the end of life   with carers, family and friends.

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The family really want to be there when their loved one dies. Can this be guaranteed?

You cannot promise someone that they will be there when their relative or friend dies as it can be very unpredictable. It’s also important to be aware that sometimes people prefer to die alone.

Some family and friends like to say goodbye every time they leave the room, just in case they are not there when death occurs. You could suggest this to the person’s loved ones. It’s very important to give the person and their family some privacy at this stage, so they can have some time alone.

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How can I handle my own feelings about the person’s death?

Caring for someone who is dying can be emotionally demanding. It’s important to recognise your own feelings and vulnerabilities, so you can take care of yourself too. Perhaps you’ve built a bond with the person you’ve been caring for, or their death reminds you of experiences and emotions from your own life, or has made you think about your own mortality. It’s important to acknowledge these thoughts and feelings.

Although you may find it difficult, if you do feel sad or find yourself close to tears, be mindful of the family’s grief and try to remain professional when you’re with them.

Consider exploring any support that may be available to you, such as clinical supervision, if you have access to it, or support from your colleagues. You may find that using a reflective process either formally or informally may help you make sense of what is happening.

If the person’s family invite you to the funeral, you may find this helpful for closure, but you’re not obliged to go. The family will understand a respectful declination. If you do decide to attend, remember to stay in the background and respect the family’s’ grief. 

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Who else should I talk to?

  • The specialist palliative care team
  • The person’s GP
  • A district nurse
  • Your supervisor or colleagues for emotional support

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Points to remember

  • Keep the person at the centre of your care during the dying process.
  • Be open and honest with the person and their family, and document any conversations you have about end of life issues.
  • If you’re in doubt about the person’s wishes or needs, speak to their family.
  • Be aware of your own feelings, and share your experience with your colleagues in a reflective manner.
  • Build your knowledge with additional information from Marie Curie and our list of other recommended sources.

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