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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
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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

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