StatPearls-/-ä 2024[Jan]; ä (ä): ä PMID33231982show ga
Physicians in both inpatient or outpatient capacity are increasingly exposed to patients with terminal illnesses in both acute settings as well while dealing with patients with chronic illnesses. In the inpatient scenario, critical care and hospitalist physicians are often charged with the management of severely ill patients that reach the 'end-of-life' stage because of an acute catastrophic event or a rapid deterioration or complication of one or more chronic comorbidities. Exposure to patients with advanced age, presence of an increasing number of chronic illnesses (such as cancer, heart failure, cerebrovascular accident, and renal failure), rising number of invasive procedures, and more recently, the effects of the novel Coronavirus infection of 2019 (COVID-19), have led the doctors caring for these patients to manage situations where death is imminent. An end-of-life patient is defined as one with a life expectancy of fewer than 12 months, per the UK General Medical Council. This includes patients likely to die within a few hours or days. If given a choice, most people, including those who are healthy, in the West, would like to die at home. Due to the factors listed above, physicians need to be aware of the principles of end-of-life care. Physicians help take care of their patients with curative intent, but when that is not possible, it is equally important for them to provide the patients the option of what many patients describe as a dignified 'good death.' Most patients describe this as "pain-free, distress free, with good symptom control, preferably in a place of choice with people of choice around them." Many would also like to be a minimum burden on their families, get their personal affairs in order before dying, and maintain mental clarity if possible while retaining a sense of value for life spent with a feeling of closure. This may be summarized in the all-encompassing phrase "comfort measures." Application of comfort measures for the terminally ill patient hence requires an understanding of the disease process, therapeutic measures for symptom relief, social situations, and mechanisms involved in the placement of such patients.
StatPearls-/-ä 2024 ; ä (ä): ä
