"Palliative" is not a dirty word, Mythbusting

Peacefully Passing in the ED.

I’ve often half-jokingly stated that I believe we treat our pets better than our family at the end of life.  Our beloved Fido dies after a run on the beach, a steak dinner, and with a slug of morphine.  Grandma?  She gets intubated without pain medication, gags a bit, and likely dies in significant distress.

We can make this process more peaceful.  There is a significant movement for emergency medicine to OWN palliative care.  We need to recognize when heroic efforts will go for naught (1 year mortality for a patient >85 years old admitted to the ICU is 97%).  We can be soothing.  We can start Fentanyl drips.  We can add on anti-secretory agents.  We can add on a bit of anxiolytics.

As per a recent study, according to the family of the deceased, what factors were associated with the perception of peaceful death?  Adequate personal attention.  Adequate personal care.  Family finds enough nurses available.  And a you can make a phone call.

Religious affiliation reflected in end-of-life decision making has been associated with the perception of a peaceful passing.  Simply offering a chaplain to come in often times is soothing to the family and provides a sense of closure.  There is something about the end of a loved ones life that brings out an inner spirituality to both atheists and believers.  This is so simple to do!  If the RN asked me if they could page the chaplain for my dying patient, I would be embarrassed I had yet to do it myself.  It is one of few things that we all could do that has been shown to influence a family members opinion that their loved one passed peacefully.

Next time it appears futile, and the end of life discussion has been had, offer a chaplain.  The discussion and reality is never going to be easy for the family.  Let’s make an honest attempt to make it less difficult.  Let’s turn off the monitor, turn on the Fentanyl drip, load the patient with hyoscine, and get the chaplain on board.

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When do people with dementia die peacefully? An analysis of data collected prospectively in long-term care settings PMID:24292158

Outcome of elderly patients with circulatory failure. PMID: 24132383

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