Edinburgh Napier University

  Background To ensure patients and families
receive appropriate end-of-life care pathways and
guidelines aim to inform clinical decision making.
Ensuring appropriate outcomes through the use
of these decision aids is dependent on timely
use. Diagnosing dying is a complex clinical
decision, and most of the available practice
checklists relate to cancer. There is a need to
review evidence to establish diagnostic indicators
that death is imminent on the basis of need
rather than a cancer diagnosis.
Aim To examine the evidence as to how
patients are judged by clinicians as being in the
final hours or days of life.
Design Integrative literature review.
Data sources Five electronic databases
(2001–2011): Cochrane Central Register of
Controlled Trials (CENTRAL) on The Cochrane
Library, MEDLINE, EMBASE, PsycINFO and
CINAHL. The search yielded a total of 576 hits,
331 titles and abstracts were screened, 42
papers were retrieved and reviewed and 23
articles were included.
Results Analysis reveals an overarching theme of
uncertainty in diagnosing dying and two
subthemes: (1) ‘characteristics of dying’ involve
dying trajectories that incorporate physical,
social, spiritual and psychological decline towards
death; (2) ‘treatment orientation’ where decision
making related to diagnosing dying may remain
focused towards biomedical interventions rather
than systematic planning for end-of-life care.
Conclusions The findings of this review support
the explicit recognition of ‘uncertainty in
diagnosing dying’ and the need to work with
and within this concept. Clinical decision making
needs to allow for recovery where that potential
exists, but equally there is the need to avoid futile interventions