"How much time do they have left?" How do you respond?

macsmith777 · Oct 24, 2009

I have learned in the past three years of hospice work that you never never never know. It frustrates me to no end when MDs give people specific timelines on their, or their loved ones deaths. I advise people that the longer I do this, the more convinced I am that no-one ever really knows. That said, there are of course circumstances where it is clear that a pt is going to die in the next few days, week, whatever. I will indicate that my experience tells me that is likely, but I always throw it the caveat that I am suprised (one way or another) as often as not. Don't feel bad about not having a concrete answer, people go in their own time. I tell families that if I knew the answer to that, I would be driving a nicer car, as I would be God. smart aleky yes, but it lightens the mood and shows that none of us know. My advice: stay away from specifics, unless you have some gift I have yet to see, you will be proven wrong.

macsmith777 · Oct 24, 2009

Oh, having read your original post more carefully I should say that I never shy from being honest in indicating that a pts death is coming soon. I have been thanked countless times for being the one who is frank with them, after having so many blow smoke. Just stay away from specifics.

**canoehead, BSN, RN** · Oct 25, 2009

I haven't experience dealing with death, but I worked in OB. When people would ask when the baby would come I'd tell them my best guess but I'd also tell them that whenever I make a prediction I am never, ever, right.

Katillac, RN · Oct 25, 2009

When asked, I tended to educate, to point toward certain things I was seeing that made me think the process was moving along, and educate as to indicators they might see in the future, but ALWAYS with ample caveats about not really knowing and every one doing it somewhat differently.

Once the generalities were out there, I'd try to assess if there were unspoken questions, like, "When should I tell the family to come?", etc. Because really, the reasons behind the question are sometimes as important as the actual question. Some want to be prepared. Some want to know how much longer they have before the precious person is taken, or indeed how much longer they need to shoulder the burden of caregiving, etc. So sometimes a follow up question is a good idea, like, "What caused you to ask me that today?"

Oh, and social work and spiritual care might be could be brought in on this, as this is a question the answer to which crosses disciplines.

ellakate · Oct 25, 2009

Ask them what the physician has told them.

Werblessed · Oct 26, 2009

CentexRN...Physicians are among the worst prognosticators when it comes to terminal patients so I wouldn't tell family to ask the physician (especially if physician is NOT hospice physician).

Families ask routinely 'how much longer do you think they have'? It is a legitimate and honest question because although their loved one's life is quieting down, their families have jobs, lives and obligations and logistically, they need to know.

Of course we don't have a magic ball to be able to tell us when someone will pass but we do have physical manifestations and our own experiences to guide us fairly close most of the time. And, yes, their are always the exception to the rule (have one 93 y/o now who has been actively dying for 15 days now and we're out daily with chaplian, social worker, nurse and c.n.a.s to rally around her and ensure she has all the support and comfort she needs to leave in her own time). Dying is a process...some skip right through and others take their time, meadering and visiting along the way. What I tell families is that based on my hospice experience I would expect the patient to pass in X days/hours. I always add that caveat of "if she becomes more responsive or perks up a bit and starts eating and drinking, then the prognosis will be longer". I also assure them that our nurses and staff will be keeping a close eye on their symptoms and comfort and will be reporting what we are seeing and expecting to happen next as we go along. As to the question of "Should I call my son/daughter/cousin to come in now? They were going to come next month..." I always encourage families to have those who feel they need to be here by the patient come sooner rather than later as we don't know precisely when the patient will pass. If they are very far from the patient and I know the patient is getting pretty close, I encourage the family to get the person on the phone and put the phone to the dying patient's ear to tell them what their hearts need to say. As we know, our patients hear until the second they let go (yeah they have those awesome hospice research supporting this but we also know from our own bedside experiences, huh?)

There is also an AWESOME booklet that most hospices provide to families of patients in our care. It's called "Gone From Our Sight" by Barbara Kearnes and it is formatted in very easy to read, large print. It explains what signs we typically see when patients are months, weeks, days and hours from passing and it does so in a very comforting and reassuring manner. It's a great teaching tool to give to your families and will help guide your own assessment as well. I'm not saying that I am right 100% of the time (because I don't get to be involved in that decision - it's between patient and their God) but I am pretty on the mark in the majority of the cases that I see. Maybe it's because I've worked in hospice for a while and maybe it's that 'nurses instinct' that tugs at my heart when I feel someone is close to death. I think it's a blessing because I can explain why I am expecting the death to occur in the timeframe I am seeing and reassure the family that we will provide the support and comfort the patient needs to pass in their own way and in their own time.

Hope that helps.

Mary