Researchers say they have identified eight highly specific physical signs that are associated with death within three days in cancer patients.
They highlight that while the diagnosis of an impending death is “always sad”, identifying when it is likely can be important for clinicians planning discharge, hospice referral and treatment.
They also noted that very few studies had examined the signs of impending death, making it difficult for healthcare professionals to make a diagnosis with confidence and to communicate this with the family.
“Simple bedside observations can potentially help us to recognize if a patient has entered the final days of life”
The University of Texas study recorded the physical changes in the final days of life in 357 cancer patients who were admitted to acute palliative care units in two cancer centres – one in the US and one in Brazil.
The study authors documented 52 physical signs every 12 hours from admission to death or discharge. During the study, 57% of the patients died.
They identified eight bedside physical signs that, if present, strongly suggest that a patient will die within three days.
These are non-reactive pupils, decreased response to verbal stimuli, decreased response to visual stimuli, inability to close eyelids, drooping of the nasolabial fold, hyperextension of the neck, grunting of vocal cords, and upper gastrointestinal bleed.
These signs may help nurses and doctors to make the diagnosis of impending death, they said online in the journal Cancer.
“This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life,” said lead 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,” he added.
The researchers are in the process of validating their results to see if they hold true in other healthcare settings, such as the home and inpatient hospices.
Eight bedside signs that strongly suggest a patient will die within three days
Decreased response to verbal stimuli
Decreased response to visual stimuli
Inability to close eyelids
Drooping of the nasolabial fold (which makes the face appear more relaxed)
Hyperextension of the neck (in which the head tilts back when the patient is lying down)
Grunting of vocal cords
Upper gastrointestinal bleed