Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-13T03:34:40.721Z Has data issue: false hasContentIssue false
  • English
  • Français

The conscious state of the dying patient: An integrative review

Published online by Cambridge University Press:  07 October 2021

Tricia O'Connor Open the ORCID record for Tricia O'Connor [Opens in a new window] ,
Catherine Paterson Open the ORCID record for Catherine Paterson [Opens in a new window] ,
Jo Gibson Open the ORCID record for Jo Gibson [Opens in a new window]  and
Karen Strickland Open the ORCID record for Karen Strickland [Opens in a new window]
Tricia O'Connor*
Affiliation:
Faculty of Health, School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia Calvary Health Care, Bruce – Clare Holland House, Canberra, ACT, Australia
Catherine Paterson
Affiliation:
Faculty of Health, School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia Australian Capital Territory (ACT) Health, Canberra Health Services, Canberra, ACT, Australia School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
Jo Gibson
Affiliation:
Faculty of Health, School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia
Karen Strickland
Affiliation:
Faculty of Health, School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia School of Nursing, Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
*
Author for correspondence: Tricia O'Connor, Faculty of Health, School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT 2601, Australia. E-mail: catherine.oconnor@canberra.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The cognitive state of the dying in the last days of life may deteriorate, resulting in a reduced ability to communicate their care needs. Distressing symptoms, physical and existential, may go unrecognized and untreated. The objectives of this integrative review were to systematically interrogate the literature to determine the changing conscious state of dying adults and to identify changes in their care needs.

Methods

An integrative review protocol was registered with PROSPERO (CRD42020160475). The World Health Organization definition of palliative care informed the review. CINAHL, MEDLINE (OVID), Scopus, PsycINFO, Cochrane Library, and PubMed were searched from inception to October 2019 using search strategies for each database. Inclusion and exclusion criteria were applied. Methodological quality was appraised using the Joanna Briggs Institute Checklist for the Case Series appraisal tool. Extracted data were synthesized using a narrative approach.

Results

Of 5,136 papers identified, 11 quantitative case series studies were included. Six themes were identified: conscious state and change over time, awareness, pain, absence of holistic care, the voiceless patient, and signs and symptoms of dying.

Significance of results

In the last days of life, the physical and conscious state of the dying patient declines, resulting in an inability to express their care needs. Dignity in dying and freedom from pain and suffering are both an imperative and a human right; and unvoiced care needs can result in unnecessary suffering and distress. This review revealed that little is known about how healthcare professionals assess holistic care needs at this vulnerable time. Although much has been written about palliative and end-of-life care, the assessment of care needs when patients are no longer able to voice their own needs has largely been ignored, with little attention from clinical, educational, or research perspectives. This gap in evidence has important implications for the dying and their families.

Keywords

CognitiveHolistic careIntegrative reviewLast days of lifePalliative care
Type
Review Article
Information
Palliative & Supportive Care , Volume 20 , Issue 5 , October 2022 , pp. 731 - 743
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. Arlington, VA: American Psychiatric Association. doi:10.1176/appi.books.9780890425596Google Scholar
Azhar, A and Bruera, E (2018) Outcome measurement and complex physical, psychosocial and spiritual experiences of death and dying. Annals of Palliative Medicine 7(Suppl 3), S231–S243. doi:10.21037/apm.2018.07.04CrossRefGoogle ScholarPubMed
Barbato, M (2001) Bispectral index monitoring in unconscious palliative care patients. Journal of Palliative Care 17(2), 102–108. doi:10.1177/082585970101700206CrossRefGoogle ScholarPubMed
Barbato, M, Barclay, G, Potter, J, et al. (2015) Sedation and analgesia in unconscious palliative care patients: Can bispectral index monitoring add to our understanding? Journal of Palliative Care 31(1), 57–59. doi:10.1177/082585971503100109CrossRefGoogle ScholarPubMed
Barbato, M, Barclay, G, Potter, J, et al. (2018) Breakthrough medication in unresponsive palliative care patients: Indications, practice, and efficacy. Journal of Pain and Symptom Management 56(6), 944–950. doi:10.1016/j.jpainsymman.2018.08.020CrossRefGoogle ScholarPubMed
Benedetti, FD, Ostgathe, C, Clark, J, et al. (2013) International palliative care experts’ view on phenomena indicating the last hours and days of life. Supportive Care in Cancer 21(6), 1509–1517. doi:10.1007/s00520-012-1677-3CrossRefGoogle Scholar
Blinderman, CD and Billings, AJ (2015) Comfort care for patients dying in the hospital. The New England Journal of Medicine 373(26), 2549–2561. doi:10.1056/NEJMra1411746CrossRefGoogle ScholarPubMed
Blundon, EG, Gallagher, RE and Ward, LM (2020) Electrophysiological evidence of preserved hearing at the end of life. Scientific Reports 10(1), 10336. doi:10.1038/s41598-020-67234-9CrossRefGoogle ScholarPubMed
Braun, V and Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3(2), 77–101. doi:10.1191/1478088706qp063oaCrossRefGoogle Scholar
Brown, R, Lau, H and LeDoux, JE (2019) Understanding the higher-order approach to consciousness. Trends in Cognitive Sciences 23(9), 754–768. doi:10.1016/j.tics.2019.06.009CrossRefGoogle ScholarPubMed
Bruera, E, Sweeney, C, Willey, J, et al. (2003) Perception of discomfort by relatives and nurses in unresponsive terminally ill patients with cancer: A prospective study. Journal of Pain and Symptom Management 26(3), 818–826. doi:10.1016/S0885-3924(03)00286-0CrossRefGoogle ScholarPubMed
Campbell, ML, Kiernan, JM, Strandmark, J, et al. (2018) Trajectory of dyspnea and respiratory distress among patients in the last month of life. Journal of Palliative Medicine 21(2), 194–199. doi:10.1089/jpm.2017.0265CrossRefGoogle ScholarPubMed
Clark, K, Connolly, A, Clapham, S, et al. (2016) Physical symptoms at the time of dying was diagnosed: A consecutive cohort study to describe the prevalence and intensity of problems experienced by imminently dying palliative care patients by diagnosis and place of care. Journal of Palliative Medicine 19(12), 1288–1295. doi:10.1089/jpm.2016.0219CrossRefGoogle ScholarPubMed
Coelho, A, de Brito, M, Teixeira, P, et al. (2020) Family caregivers’ anticipatory grief: A conceptual framework for understanding its multiple challenges. Qualitative Health Research 30(5), 693–703. doi:10.1177/1049732319873330CrossRefGoogle ScholarPubMed
Covidence Systematic Review Software. Melbourne, Australia: Veritas Health Innovation. Available at: www.covidence.org.Google Scholar
Donnelly, S, Prizeman, G, Ó Coimín, D, et al. (2018) Voices that matter: End-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC Palliative Care 17(1), 117–113. doi:10.1186/s12904-018-0365-6CrossRefGoogle ScholarPubMed
Epstein, NE (2014) Multidisciplinary in-hospital teams improve patient outcomes: A review. Surgical Neurology International 5(Suppl 7), S295–S303. doi:10.4103/2152-7806.139612CrossRefGoogle ScholarPubMed
Etkind, SN, Bone, AE, Gomes, B, et al. (2017) How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Medicine 15, 102. doi:10.1186/s12916-017-0860-2CrossRefGoogle Scholar
Eychmüller, S, Benedetti, FD, Latten, R, et al. (2013) “Diagnosing dying" in cancer patients: A systematic literature review. European Journal of Palliative Care 20(6), 292–296.Google Scholar
Fainsinger, R, Miller, MJ, Bruera, E, et al. (1991) Symptom control during the last week of life on a palliative care unit. Journal of Palliative Care 7(1), 5–11.Google ScholarPubMed
Feigin, S, Owens, RG and Goodyear-Smith, F (2019) Helping a loved one die: The act of assisted dying in New Zealand. Mortality 24(1), 95–110. doi:10.1080/13576275.2017.1382461CrossRefGoogle Scholar
Freeman, B (2015) Compassionate Person-Centered Care for the Dying: An Evidence-Based Palliative Care Guide for Nurses. New York: Springer Publishing Company, LLC.CrossRefGoogle Scholar
Gao, X, Prigerson, HG, Diamond, EL, et al. (2013) Minor cognitive impairments in cancer patients magnify the effect of caregiver preferences on end-of-life care. Journal of Pain and Symptom Management 45(4), 650–659. doi:10.1016/j.jpainsymman.2012.03.003CrossRefGoogle ScholarPubMed
Geijteman, ECT, van der Graaf, M, Witkamp, FE, et al. (2018) Interventions in hospitalised patients with cancer: The importance of impending death awareness. BMJ Supportive & Palliative Care 8(3), 278–281. doi:10.1136/bmjspcare-2017-001466CrossRefGoogle ScholarPubMed
Herr, K, Coyne, PJ, McCaffery, M, et al. (2011) Pain assessment in the patient unable to self-report: Position statement with clinical practice recommendations. Pain Management Nursing 12(4), 230–250. doi:10.1016/j.pmn.2011.10.002CrossRefGoogle ScholarPubMed
Herr, K, Coyne, PJ, Ely, E, et al. (2019) Pain assessment in the patient unable to self-report: Clinical practice recommendations in support of the ASPMN 2019 position statement. Pain Management Nursing 20(5), 404–417. doi:10.1016/j.pmn.2019.07.005CrossRefGoogle ScholarPubMed
Hickman, LD, Phillips, JL, Newton, PJ, et al. (2015) Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review. Archives of Gerontology and Geriatrics 61(3), 322–329. doi:10.1016/j.archger.2015.06.021CrossRefGoogle ScholarPubMed
Hjermstad, MJ, Gibbins, J, Haugen, DF, et al. (2008) Pain assessment tools in palliative care: An urgent need for consensus. Palliative Medicine 22(8), 895–903. doi:10.1177/0269216308095701CrossRefGoogle ScholarPubMed
Hjermstad, MJ, Fayers, PM, Haugen, DF, et al. (2011) Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: A systematic literature review. Journal of Pain and Symptom Management 41(6), 1073–1093. doi:10.1016/j.jpainsymman.2010.08.016CrossRefGoogle ScholarPubMed
Hosie, A, Davidson, PM, Agar, M, et al. (2013) Delirium prevalence, incidence, and implications for screening in specialist palliative care inpatient settings: A systematic review. Palliative Medicine 27, 486–498. doi:10.1177/0269216312457214CrossRefGoogle ScholarPubMed
Hosie, A, Siddiqi, N, Featherstone, I, et al. (2019) Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review. Palliative Medicine 33(8), 878–899. doi:10.1177/0269216319853487CrossRefGoogle ScholarPubMed
Hui, D (2019) Delirium in the palliative care setting: “sorting” out the confusion. Palliative Medicine 33(8), 863–864. doi:10.1177/0269216319861896CrossRefGoogle ScholarPubMed
Hui, D and Bruera, E (2017) The edmonton symptom assessment system 25 years later: Past, present, and future developments. Journal of Pain and Symptom Management 53(3), 630–643. doi:10.1016/j.jpainsymman.2016.10.370CrossRefGoogle ScholarPubMed
Hui, D, dos Santos, R, Chisholm, G, et al. (2015a) Bedside clinical signs associated with impending death in patients with advanced cancer: Preliminary findings of a prospective, longitudinal cohort study. Cancer 121(6), 960–967. doi:10.1002/cncr.29048CrossRefGoogle Scholar
Hui, D, dos Santos, R, Chisholm, GB, et al. (2015b) Symptom expression in the last seven days of life among cancer patients admitted to acute palliative care units. Journal of Pain and Symptom Management 50(4), 488–494. doi:10.1016/j.jpainsymman.2014.09.003CrossRefGoogle Scholar
Kastbom, L, Milberg, A and Karlsson, M (2016) A good death from the perspective of palliative cancer patients. Supportive Care in Cancer 25(3), 933–939. doi:10.1007/s00520-016-3483-9CrossRefGoogle ScholarPubMed
Kehl, KA and Kowalkowski, JA (2013) A systematic review of the prevalence of signs of impending death and symptoms in the last 2 weeks of life. American Journal of Hospice and Palliative Medicine 30(6), 601–616. doi:10.1177/1049909112468222CrossRefGoogle ScholarPubMed
Kennedy, C, Brooks-Young, P, Brunton Gray, C, et al. (2014) Diagnosing dying: An integrative literature review. BMJ Supportive & Palliative Care 4(3), 263–270. doi:10.1136/bmjspcare-2013-000621CrossRefGoogle ScholarPubMed
Kitson, A, Carr, D, Conroy, T, et al. (2019) Speaking up for fundamental care: The ILC aalborg statement. BMJ Open 9(12). doi:10.1136/bmjopen-2019-033077CrossRefGoogle ScholarPubMed
Koch, C (2018) What is consciousness? Nature 557(7704), S8–S12. doi:10.1038/d41586-018-05097-xCrossRefGoogle ScholarPubMed
Krooupa, A-M, Vivat, B, McKeever, S, et al. (2019) Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE. Palliative Medicine 34(1), 83–113. doi:10.1177/0269216319871666CrossRefGoogle ScholarPubMed
Kuusisto-Gussmann, E, Höckelmann, C, von der Lühe, V, et al. (2021) Patients’ experiences of delirium: A systematic review and meta-summary of qualitative research. Journal of Advanced Nursing. doi:10.1111/jan.14865CrossRefGoogle ScholarPubMed
Lawlor, PG, Davis, DHJ, Ansari, M, et al. (2014) An analytical framework for delirium research in palliative care settings: Integrated epidemiologic, clinician-researcher, and knowledge user perspectives. Journal of Pain and Symptom Management 48(2), 159–175. doi:10.1016/j.jpainsymman.2013.12.245CrossRefGoogle ScholarPubMed
Lichter, I and Hunt, E (1990) The last 48 hours of life. Journal of Palliative Care 6(4), 7–15.CrossRefGoogle Scholar
Lunney, JR, Lynn, J, Foley, DJ, et al. (2003) Patterns of functional decline at the end of life. Journal of the American Medical Association 289(18), 2387–2392. doi:10.1001/jama.289.18.2387CrossRefGoogle ScholarPubMed
Maeda, I, Ogawa, A, Yoshiuchi, K, et al. (2020) Safety and effectiveness of antipsychotic medication for delirium in patients with advanced cancer: A large-scale multicenter prospective observational study in real-world palliative care settings. General Hospital Psychiatry 67, 35. doi:10.1016/j.genhosppsych.2020.09.001CrossRefGoogle ScholarPubMed
Mah, K, Rodin, RA, Chan, VWS, et al. (2017) Health-care workers’ judgments about pain in older palliative care patients with and without delirium. American Journal of Hospice & Palliative Medicine 34(10), 958–965. doi:10.1177/1049909116672641CrossRefGoogle ScholarPubMed
Matsunami, K, Tomita, K, Touge, H, et al. (2018) Physical signs and clinical findings before death in ill elderly patients. American Journal of Hospice & Palliative Medicine 35(4), 712–717. doi:10.1177/1049909117733661CrossRefGoogle ScholarPubMed
Matzo, M and Hill, JA (2019) Peri-death nursing care. In Matzo, M and Sherman, DW (eds.), Palliative Care Nursing: Quality Care to the End of Life, 5th ed. Springer Publishing Company, pp. 649–674. doi:10.1891/9780826127198Google Scholar
McColl, E (2004) Best practice in symptom assessment: A review. Gut 53(Suppl 4), iv49–iv54. doi:10.1136/gut.2003.034355CrossRefGoogle ScholarPubMed
McGuire, DB, Kaiser, KS, Haisfield-Wolfe, ME, et al. (2016) Pain assessment in noncommunicative adult palliative care patients. Nursing Clinics of North America 51(3), 397–431. doi:10.1016/j.cnur.2016.05.009CrossRefGoogle ScholarPubMed
Meier, EA, Gallegos, JV, Thomas, LPM, et al. (2016) Defining a good death (successful dying): Literature review and a call for research and public dialogue. The American Journal of Geriatric Psychiatry 24(4), 261–271. doi:10.1016/j.jagp.2016.01.135CrossRefGoogle Scholar
Moens, K, Higginson, IJ, Harding, R, et al. (2014) Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. Journal of Pain and Symptom Management 48(4), 660–677. doi:10.1016/j.jpainsymman.2013.11.009CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. British Medical Journal. 2535. doi:10.1136/bmj.b2535CrossRefGoogle ScholarPubMed
Moola, S, Munn, Z, Tufanaru, C, et al. (2017) Chapter 7: Systematic reviews of etiology and risk. In Aromataris, E and Munn, Z (eds.), JBI Manual for Evidence Synthesis. The Joanna Briggs Institute. Available at: https://reviewersmanual.joannabriggs.org/.Google Scholar
Morita, T, Ichiki, T, Tsunoda, J, et al. (1998) A prospective study on the dying process in terminally ill cancer patients. American Journal of Hospice and Palliative Medicine 15(4), 217–222. doi:10.1177/104990919801500407CrossRefGoogle ScholarPubMed
Murray, SA, Kendall, M, Boyd, K, et al. (2005) Illness trajectories and palliative care. BMJ 330(7498), 1007–1011. doi:10.1136/bmj.330.7498.1007CrossRefGoogle ScholarPubMed
Naccache, L (2017) Minimally conscious state or cortically mediated state? Brain 141(4), 949–960. doi:10.1093/brain/awx324CrossRefGoogle Scholar
Nadimi, F and Currow, DC (2011) As death approaches: A retrospective survey of the care of adults dying in Alice Springs Hospital. Australian Journal of Rural Health 19(1), 4–8. doi:10.1111/j.1440-1584.2010.01169.xCrossRefGoogle ScholarPubMed
NICE (2017) Care of Dying Adults in the Last Days of Life: Quality Standard. National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/qs144Google Scholar
Palliative Care Australia (2018) National Palliative Care Standards. Available at: https://palliativecare.org.au/Google Scholar
Pereira, MED, Barbosa, A and Dixe, MdA (2018) Palliative care for end-of-life patients in a basic emergency service. Scandinavian Journal of Caring Sciences 32(3), 1056–1063. doi:10.1111/scs.12551CrossRefGoogle Scholar
Plonk, WM and Arnold, RM (2005) Terminal care: The last weeks of life. Journal of Palliative Medicine 8(5), 1042. doi:10.1089/jpm.2005.8.1042CrossRefGoogle ScholarPubMed
Quinn, KL, Shurrab, M, Gitau, K, et al. (2020) Association of receipt of palliative care interventions with health care use, quality of life, and symptom burden among adults with chronic noncancer illness: A systematic review and meta-analysis. JAMA 324(14), 1439–1450. doi:10.1001/jama.2020.14205CrossRefGoogle ScholarPubMed
Rady, MY and Verheijde, JL (2013) Deep sedation at the end of life: Life-shortening effect and palliative efficacy. American Journal of Hospice and Palliative Medicine 30(1), 100–101. doi:10.1177/1049909112462863CrossRefGoogle ScholarPubMed
Rady, MY and Verheijde, JL (2016) Neuroscience and awareness in the dying human brain: Implications for organ donation practices. Journal of Critical Care 34, 121–123. doi:10.1016/j.jcrc.2016.04.016CrossRefGoogle ScholarPubMed
Robinson, J, Moeke-Maxell, T, Parr, J, et al. (2019) Optimising compassionate nursing care at the end of life in hospital settings. Journal of Clinical Nursing 29(11–12), 1788–1796. doi:10.1111/jocn.15050CrossRefGoogle ScholarPubMed
Rodríguez-Prat, A, Monforte-Royo, C, Porta-Sales, J, et al. (2016) Patient perspectives of dignity, autonomy and control at the end of life: Systematic review and meta-ethnography. PLoS ONE 11(3), e0151435. doi:10.1371/journal.pone.0151435CrossRefGoogle ScholarPubMed
Roest, B, Trappenburg, M and Leget, C (2019) The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: A systematic mixed studies review. BMC Medical Ethics 20(1), 1–21. doi:10.1186/s12910-019-0361-2CrossRefGoogle ScholarPubMed
Sandvik, RK, Selbaek, G, Bergh, S, et al. (2016) Signs of imminent dying and change in symptom intensity during pharmacological treatment in dying nursing home patients: A prospective trajectory study. Journal of the American Medical Directors Association 17(9), 821–827. doi:10.1016/j.jamda.2016.05.006CrossRefGoogle ScholarPubMed
Sarà, M and Pistoia, F (2010) Defining consciousness: Lessons from patients and modern techniques. Journal of Neurotrauma 27(4), 771. doi:10.1089/neu.2008.0804CrossRefGoogle ScholarPubMed
Saunders, C (2006) The problem of euthanasia (care of the dying—1). In Cicely Saunders: Selected Writings 1958–2004. Oxford University Press, pp. 133–138. doi:10.1093/acprof:oso/9780198570530.001.0001CrossRefGoogle Scholar
Sekse, RJT, Hunskår, I and Ellingsen, S (2018) The nurse's role in palliative care: A qualitative meta-synthesis. Journal of Clinical Nursing 27(1–2), e21–e38. doi:10.1111/jocn.13912CrossRefGoogle ScholarPubMed
Stiel, S, Heckel, M, Frauendorf, T, et al. (2015) Comparison of terminally ill cancer vs. non-cancer patients in specialized palliative home care in Germany: A single service analysis. BMC Palliative Care 14, 34. doi:10.1186/s12904-015-0033-zCrossRefGoogle ScholarPubMed
Tapp, D, Chenacher, S, Gérard, NPA, et al. (2019) Observational pain assessment instruments for use with nonverbal patients at the end-of-life: A systematic review. Journal of Palliative Care 34(4), 255–266. doi:10.1177/0825859718816073CrossRefGoogle ScholarPubMed
The Institute of Medicine Committee on Approaching Death: Addressing Key End-of-Life Issues (2014) Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. National Academies Press. doi:10.17226/18748Google Scholar
The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party (2014) Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation. The Joanna Briggs Institute. Available at: https://joannabriggs.org/sites/default/files/2019-05/JBI-Levels-of-evidence_2014_0.pdfGoogle Scholar
Thier, K, Calabek, B, Tinchon, A, et al. (2016) The last 10 days of patients with glioblastoma: Assessment of clinical signs and symptoms as well as treatment. American Journal of Hospice & Palliative Medicine 33(10), 985–988. doi:10.1177/1049909115609295CrossRefGoogle ScholarPubMed
Turner, K, Chye, R, Aggarwal, G, et al. (1996) Dignity in dying: A preliminary study of patients in the last three days of life. Journal of Palliative Care 12(2), 7–13.CrossRefGoogle ScholarPubMed
Van Gulick, R (2012) Consciousness and cognition. In Margolis, E, Samuels, R & Stich, SP (eds.), The Oxford Handbook of Philosophy of Cognitive Science. Oxford: Oxford University Press. doi:10.1093/oxfordhb/9780195309799.013.0002Google Scholar
Waller, A, Chan, S, Chan, CWH, et al. (2020) Perceptions of optimal end-of-life care in hospitals: A cross-sectional study of nurses in three locations. Journal of Advanced Nursing. doi:10.1111/jan.14510CrossRefGoogle ScholarPubMed
Watt, CL, Scott, M, Webber, C, et al. (2021) Delirium screening tools validated in the context of palliative care: A systematic review. Palliative Medicine 35(4), 683–696. doi:10.1177/0269216321994730CrossRefGoogle ScholarPubMed
White, N, Reid, F, Harries, P, et al. (2019) The (un)availability of prognostic information in the last days of life: A prospective observational study. BMJ Open 9(7). Article e030736. doi:10.1136/bmjopen-2019-030736CrossRefGoogle ScholarPubMed
Whittemore, R and Knafl, K (2005) The integrative review: Updated methodology. Journal of Advanced Nursing 52(5), 546–553. doi:10.1111/j.1365-2648.2005.03621.xCrossRefGoogle ScholarPubMed
Wiegand, DL, Wilson, T, Pannullo, D, et al. (2018) Measuring acute pain over time in the critically ill using the multidimensional objective pain assessment tool (MOPAT). Pain Management Nursing 19(3), 277–287. doi:10.1016/j.pmn.2017.10.013CrossRefGoogle Scholar
World Health Organization (2020) WHO Definition of Palliative Care. Available at: https://www.who.int/cancer/palliative/definition/en/.Google Scholar
Zwakhalen, SMG, Hamers, JPH, Metzelthin, SF, et al. (2018) Basic nursing care: The most provided, the least evidence based – A discussion paper. Journal of Clinical Nursing 27(11–12), 2496–2505. doi:10.1111/jocn.14296CrossRefGoogle ScholarPubMed
Supplementary material: File

O'Connor et al. supplementary material

O'Connor et al. supplementary material 1

Download O'Connor et al. supplementary material(File)
File 24.3 KB
Supplementary material: File

O'Connor et al. supplementary material

O'Connor et al. supplementary material 2

Download O'Connor et al. supplementary material(File)
File 15.6 KB