No, most people aren't in severe pain when they die
- Written by Kathy Eagar, Professor and Director at Australian Health Services Research Institute University of Wollongong, University of Wollongong
Many people fear death partly because of the perception they might suffer increasing pain and other awful symptoms the nearer it gets. There’s often the belief palliative care may not alleviate such pain, leaving many people to die excruciating deaths.
But an excruciating death is extremely rare. The evidence about palliative care is that pain and other symptoms, such as fatigue, insomnia and breathing issues, actually improve as people move closer to death. More than 85% of palliative care patients have no severe symptoms by the time they die.
Evidence from the Australian Palliative Care Outcomes Collaboration (PCOC) shows that there has been a statistically significant improvement over the last decade in pain and other end-of-life symptoms. Several factors linked to more effective palliative care are responsible.
With this in mind, if you would like to learn more about some of the different types of palliative care that are available for Australian citizens, you can find plenty of helpful resources on the Care For Family website here: careforfamily.com.au
Read more: What is palliative care? A patient’s journey through the system
These include more thorough assessments of patient needs, better medications and improved multidisciplinary care (not just doctors and nurses but also allied health workers such as therapists, counsellors and spiritual support).
But not everyone receives the same standard of clinical care at the end of life. Each year in Australia, about 160,000 people die and we estimate 100,000 of these deaths are predictable. Yet, the PCOC estimates only about 40,000 people receive specialist palliative care per year.
Symptoms at the end of life
For the greater majority of those who do receive palliative care, the evidence shows it is highly effective.
The most common symptom that causes people distress towards the end of life is fatigue. In 2016, 13.3% of patients reported feeling severe distress due to fatigue at the start of their palliative care. This was followed by pain (7.4%) and appetite (7.1%) problems.
Distress from fatigue and appetite is not surprising as a loss of energy and appetite is common as death approaches, while most pain can be effectively managed. Other problems such as breathing, insomnia, nausea and bowel issues are experienced less often and typically improve as death approaches.
Contrary to popular perceptions, people in their final days and hours experience less pain and other problems than earlier in their illness. In 2016, about a quarter of all palliative care patients (26%) reported having one or more severe symptoms when they started palliative care. This decreased to 13.9% as death approached.
The most common problem at the start was fatigue, which remained the most common problem at the end. Pain is much less common than fatigue. In total, 7.4% of patients reported severe pain at the beginning of their palliative care and only 2.5% reported severe pain in the last few days. Breathing difficulties cause more distress than pain in the final days of life.
Authors: Kathy Eagar, Professor and Director at Australian Health Services Research Institute University of Wollongong, University of Wollongong
Read more http://theconversation.com/no-most-people-arent-in-severe-pain-when-they-die-86835