End-of-life care, comfort and personal wishes

Palliative care can begin early in serious illness

Palliative care addresses physical, psychological, social, and spiritual suffering associated with serious illness, aiming to improve quality of life for the person and family. It can begin early and accompany surgery, cancer treatment, or treatment for cardiac and respiratory disease. It is not limited to the last days and does not mean that treatment has been abandoned. Symptoms and support needs justify involvement without requiring all life-prolonging care to stop first.

End-of-life care supports people approaching death and may continue for an extended period. The dying phase usually refers to changes in the final hours or days, although exact timing is difficult to predict. Hospice eligibility and service organization vary across places; a local payment rule is not a universal medical definition. Regardless of labels, pain relief, communication, functional support, and family assistance should respond to need rather than create a false choice between treatment and care. WHO: Palliative care

Place treatment goals in everyday life

A treatment may extend life or relieve symptoms while also adding admissions, procedures, and adverse effects. Ask which problem it is intended to solve, how likely benefit is, when improvement might appear, what burdens it brings, and what may happen without it. For someone hoping to attend a family wedding, remaining alert, reducing hospital travel, and controlling breathlessness may matter alongside survival. Age, disability, or a diagnostic label cannot automatically determine those priorities.

Prognosis usually involves a range and trajectory rather than a precise date. Clinicians can discuss more likely, better, and worse possibilities and explain what would prompt reassessment. Where appropriate, uncertainty can be addressed through a time-limited treatment trial with agreed goals and review points. Changing a burdensome intervention requires shared discussion and clinical judgment while symptom relief, nursing, and support continue. Reducing one intervention does not mean that care ends. NCI: Palliative care in cancer

Symptom relief is active clinical work

Pain, breathlessness, nausea, constipation, anxiety, and delirium can reinforce one another. Pain disrupts sleep, while fear can intensify distress. Breathlessness involves respiratory effort, neural perception, and emotion as well as oxygen levels. Assessment should include severity, triggers, timing, and effects, with a search for treatable causes. Positioning, environment, companionship, and medicines can be combined according to the problem. Oxygen is not the answer to every episode of breathlessness, and agitation is not automatically an indication for sedation.

Opioids can be appropriate for pain and some breathlessness, with individualized prescribing, adjustment, and monitoring. Constipation, drowsiness, and other adverse effects also need active management. This lesson does not provide a self-dosing plan. Proper relief aims at comfort and function rather than intentionally hastening death. Persistent uncontrolled symptoms call for early professional review and an accessible contact plan, reducing avoidable waiting and uncertainty for the person and family. NCI: End-of-life care

Source: NCI: Last days of life

Explain changes near death without automatic rules

Near death, people may sleep more, become weaker, eat or swallow less, and develop circulatory or breathing-pattern changes. Families may interpret reduced intake or noisy breathing as evidence that the person is being starved or must be suffering intensely. Clinicians should explain possible changes in the dying process while assessing thirst, pain, infection, and other treatable contributors. Recognition of dying does not remove the obligation to observe and respond. NHS: Changes in the last hours and days

Food and drink decisions consider alertness, safe swallowing, comfort, and preferences. Small amounts can provide enjoyment when safe, and mouth and lip care remain important. Forced feeding may increase choking or distress. Assisted hydration or nutrition requires comparison of individual goals, possible benefit, and burdens such as fluid retention; neither universal provision nor automatic withdrawal is appropriate. Medicine routes may also need adjustment. Clear explanations help families understand the reasons for decisions rather than leaving them to judge clinical questions through fear or guilt. NCI: Last days of life

Discuss wishes and specify each decision’s scope

Advance care planning is a series of conversations about values, goals, acceptable burdens, and possible future care. Discuss who should participate, important relationships or rituals, preferred settings, and who could help explain wishes if communication becomes impossible. Records should be accessible and reviewed because health and preferences can change. Formal documents, proxy authority, and legal effect differ across jurisdictions and require local verification; this lesson is not jurisdiction-specific legal guidance. NHS: Why plan ahead?

A decision not to attempt cardiopulmonary resuscitation concerns attempted resuscitation after arrest. It does not automatically exclude antibiotics, oxygen, transfusion, nutrition, analgesia, or other appropriate treatment; those decisions require separate consideration. Age or disability alone should not determine a blanket plan. In an actual emergency without a verified applicable medical instruction, contact emergency services and follow professional guidance. A classroom discussion cannot establish that a particular person should not be resuscitated. Specificity prevents conflicting interpretations. NHS: DNACPR decisions

Make preferred care practically available

A preference for care at home requires more than family agreement. Confirm symptom medicines, equipment, daytime and nighttime contacts, visiting services, transfer arrangements, caregiver capacity and rest, and an alternative setting if circumstances change. Hospital admission because home resources are insufficient is not a failure by the person or family. Place is only one dimension of quality, alongside comfort, respect, access, and reliable support.

Families may experience grief during illness as well as after death, with practical tasks and emotional changes occurring together. Support should allow cultural and individual variation instead of imposing fixed stages or deadlines. Persistent severe impairment, profound hopelessness, or safety concerns need professional attention. Affordable services, essential medicines, and continuity are also responsibilities of health systems. Studying end-of-life care means learning how to keep attending carefully to a particular person and their relationships when time is limited and outcomes are uncertain. NHS: What end-of-life care involves

Bilingual terms

舒缓医疗 · palliative care

Care improving quality of life through assessment and relief of suffering associated with serious illness.

预后 · prognosis

An estimate of likely disease course and outcomes, usually with uncertainty.

预先照护计划 · advance care planning

Ongoing discussion and recording of values, goals, and wishes for possible future care.

限时治疗试用 · time-limited treatment trial

A treatment trial with agreed goals and a defined review point.

不实施心肺复苏 · do not attempt cardiopulmonary resuscitation

A specific decision about not attempting CPR after arrest, not a decision to stop all care.

Sources and further reading

• WHO: Palliative care
• NCI: Palliative care in cancer
• NCI: End-of-life care
• NCI: Last days of life
• NHS: DNACPR decisions
• NHS: What end-of-life care involves
• NHS: Why plan ahead?
• NHS: Changes in the last hours and days

Original course source-check record: 9 September 2026. Full Chinese and English sentence-by-sentence language review: 14 September 2026. AI editing and language review are not human clinical review. Linked institutions have not participated in or endorsed this course.