Thinking about and planning for the end-of-life can be a difficult time for patients and their families. Each person will have unique needs and will cope in different ways. This time is easier when patients, families, and health care providers talk openly about end-of-life plans. For many patients and their families, this can be a time of personal growth. These events often give people the chance to find out more about themselves and appreciate what is most important to them.
This summary discusses care during the last days and last hours of life, including treatment of common symptoms and ethical questions that may come up. It may help patients and their families prepare for the kinds of decisions that may be needed during this time.
This summary is about end-of-life in adults with cancer and where noted, children with cancer.
When treatment choices and plans are discussed before the last days of life, it can lower the stress on both the patient and the family. Knowing the patient's wishes can help make it easier for family members to make major decisions for the patient during a very emotional time. It is most helpful if end-of life planning and decision-making begin soon after diagnosis and continue during the course of the disease. Having these decisions in writing can make the patient's wishes clear to both the family and the health care team. When it is a child who is terminally ill, having these discussions with the child's doctor may reduce the time the child spends in the hospital and help the parents feel more prepared for the child's end of life.
End-of-life planning usually includes making choices about the following:
The goal of palliative care is to improve the patient's and the family's quality of life by preventing and relieving suffering. This includes treating physical symptoms such as pain, and dealing with emotional, social, and spiritual concerns.
When palliative treatment is given at the end of life, care is taken to make sure the patient's wishes about treatments he or she wants to receive are followed.
Hospice is a program that gives care to people who are near the end of life and have stopped treatment to cure or control their cancer. Hospice care is usually meant for patients who are not expected to live longer than six months. Hospice care focuses on quality of life rather than length of life. The goal of hospice is to help patients live each day to the fullest by making them comfortable and relieving their symptoms. This may include palliative care to control pain and other symptoms so the patient can be as alert and comfortable as possible. Services to help and support the emotional, social, and spiritual needs of patients and their families are also an important part of hospice care.
Hospice programs are designed to keep a patient at home with family and friends, but hospice programs also provide services in hospice centers and in some hospitals and nursing home facilities. The hospice team includes doctors, nurses, spiritual advisors, social workers, nutritionists, and volunteers. Team members are specially trained on issues that occur at the end-of-life. After the patient's death, the hospice program continues to offer support, including grief or bereavement counseling.
(See the PDQ summary on