End-of-life predictions in advanced cancer: nurses' perspectives and the possible role of contact-free vital sign monitoring-a prospective exploratory observational study.

BACKGROUND

Experienced nurses working in palliative care units might sense patients approaching death. This study aimed to identify the most frequent characteristic actions exhibited by nurses two weeks prior to death and the physical changes observed in patients for whom the approach of death was predicted.

METHODS

This prospective observational study included 40 adult patients with advanced cancer who were admitted to the palliative care ward of a Japanese cancer hospital. Nurses' nine actions, possibly associated with the prediction of approaching death, were predetermined, and their timing and frequency were determined by chart review. A contact-free non-restraining bed sensor system (BSS) was used to continuously measure vital signs, including respiratory and pulse rates and activity patterns from admission to discharge due to death.

RESULTS

Thirty-five patients were successfully analyzed. Radial artery palpation (57%) was the nurse's action with the highest frequency during the 3-14 days before death among the nine actions. Comparison of physical and physiological variables detected by the non-contact monitoring device three days prior to the day of radial artery palpation revealed increases in nocturnal body movement activity (51 vs. 55 g/s, P=0.046), respiratory rate instability (11.5% vs. 11.9%, P=0.02), and time spent in bed during the day (98.2% vs. 98.8%, P=0.008).

CONCLUSIONS

Radial artery palpation is a key action performed when nurses sense approaching death within 3-14 days. Non-contact continuous physical monitoring may increase the accuracy of nurses' predictions of approaching death and help medical personnel provide excellent care.