The end of days

No, this article is not about the end of the world. It is about something that many people associate with the final days or weeks of life; Palliative care.

One of the major shifts in modern medicine is recognizing that treating a disease alone is not enough, especially for patients with chronic and life-limiting conditions who experience distressing and complex symptoms, such as brain injury, cancer, advanced heart, lung, or kidney disease, or dementia. These conditions can cause anxiety, not only for patients, but also for their families. While patients usually struggle with fear of uncertainty and loss of independence, families often carry heavy burdens as caregivers, which impact their mental health and family dynamics.

This is where palliative care comes in. It is a proactive approach focused on improving quality of life for patients, and it can be delivered alongside active treatments like chemotherapy, surgery, or dialysis. It provides symptoms management using medications, non-drug therapies, and communication, combined with emotional and psychological care to support patients live as well as possible for as long as possible.

Advance care planning is a key component of this process. It helps patients express their wishes and make decisions about their care while they are still able to do so. This includes decisions regarding hospital admissions, the use of certain medications and procedures, and resuscitation preferences.

From a personal perspective, I have witnessed the impact of palliative care through the experience of my own family members in hospital settings. It is not only clinical care; the palliative care team helped prepare both the patient and our family for what was ahead.

Conversations around treatment options, prognosis, and preferences were handled with honesty and compassion, allowing time for adjustment, understanding, and meaningful moments together. While difficult, this preparation made quite a difference in how we perceived and remembered the experience.

In multicultural societies, palliative care extends beyond hospitals. It is frequently delivered in the community, either at home or within the residential aged care facilities.

For many families, caring for loved ones at home is connected to cultural, spiritual, and religious beliefs; including specific practices around food, prayer, family members’ roles, and end-of-life rituals. Being cared at home allows patients to remain in a familiar environment surrounded by family, which significantly improve their comfort.

The practice on how palliative care is provided varies by condition. For example, while supporting patients with advanced lung disease, a low dose opioid is often used to help with breathlessness, anti-cholinergic medicine is used to help reduce mucus production, combined with breathing techniques.

For patients with dementia, this may include pain management with paracetamol, or a low dose opioid for more severe pain and breathlessness. Sedation might be carefully considered when the patient becomes agitated or distressed. When swallowing becomes difficult, medicines will be changed into liquid or subcutaneous to maintain comfort.

Assisting with eating and drinking is important to maintain nutrition and hydration, as well as repositioning to prevent pressure wounds. Regular medication reviews, emotional support for the patients and family as carers, and advanced care planning are the other focuses.

Another example is for patients with a non-operable brain haemorrhage or bleeding in the brain. In these cases, the palliative care team works to prevent distress as life support is withdrawn or as the disease takes its natural course.

According to the National Institute of Health, to combat severe pain and the sensation of breathlessness caused by brain stem pressure, low dose opioid is administered. Anti-cholinergic medicine is used to clear the fluid in the upper airways to eliminate the “death rattle” sound.

Beyond medication, routine interventions such as vital sign and blood checks are stopped to ensure a peaceful environment. The nursing staff prioritizes intensive oral care to keep the mouth moist, and schedules frequent repositioning to maintain comfort.  Counselling will also be provided to help family members process the rapid changes and navigate the dying process.

A qualitative study published in the American Journal of Clinical Oncology found that patients and caregivers valued early palliative care referral because it provided prompt attention to symptoms needs, timely information, and a sense of support for the future. It also associated with lower hospital readmission rates by improving symptom control, clarifying goals of care and supporting patients to remain well at home.

Often misunderstood and underutilized as something that is only accessible at the very end of life, palliative care represents a truly patient-centred medicine. It acknowledges that while not all illnesses can be cured, all patients can and should be cared for. It is not about giving up; it is a holistic approach focusing on comfort and dignity, bringing peace of mind near the end of our days – and in some cases, it can even improve survival.