The clinical course of a dying pt may largely be predictable. Figure 9-1 shows common and uncommon changes during the last days of life. Informing families that these changes might occur can help minimize the distress that they cause. In particular, the physician needs to be sensitive to the sense of guilt and helplessness that family members feel. They should be reassured that the illness is taking its course and their care of the pt is not at fault in any way. The pt stops eating because they are dying; they are not dying because they have stopped eating. Families and caregivers should be encouraged to communicate directly with the dying pt whether or not the pt is unconscious. Holding the pt's hand may be a source of comfort to both the pt and the family member/caregiver. Table 9-5 provides a listing of some changes in the pt's condition in the final hours and advice on how to manage the changes.

Additional resources for managing terminally ill pts may be found at the following websites: www.epec.net, www.eperc.mcw.edu, www.capc.org, and www.nhpco.org.