Comparative analysis of symptom burdens and influential factors among diverse terminally-ill patients.

BACKGROUND: The suffering experienced by terminally-ill patients encompasses physiological, psychosocial and spiritual dimensions. While previous studies have investigated symptom burden intensity for specific disease groups, such as cancer or heart failure patients, a research gap exists in understanding major distressing symptoms among diverse terminally-ill patients. This study assessed symptom burden intensity and explored its influential factors among diverse patient disease groups. METHODS: This cross-sectional study utilized the baseline Integrated Palliative care Outcome Scale (IPOS) assessment data. The study participants were terminally-ill patients enrolled in an end-of-life care (EoLC) intervention in Hong Kong. Statistical methods including relative importance index (RII), one-way analysis of variance (ANOVA), and generalized linear regression (GLR) were employed. RESULTS: Final sample consisted of 1,549 terminally-ill patients (mean age =77.4 years, SD =11.6). The five top-rated distressing symptoms among these patients, revealed by the RII analysis, were poor mobility (RII =64.4%), family anxiety (RII =63.5%), sharing feelings with family/friends (RII =61.4%), weakness/lack of energy (RII =58.1%), and hardly feeling at peace (RII =50.7%). One-way ANOVA showed significant differences among the eight disease groups in perceived physical and emotional symptom burden intensity (P<0.05). Analysis of RII symptom scores for each disease group revealed that poor mobility was rated as the most distressing symptom (RII =85.1-62.9%) by patients with motor neurone disease, Parkinson's disease, heart failure, dementia, end-stage renal disease and other serious diseases (including stroke, hematological disease, multiple sclerosis and liver diseases). Perceived family anxiety (RII =66.1%) and shortness of breath (RII =63.8%) were the most distressing symptoms for cancer patients and those with chronic obstructive pulmonary disease, respectively. GLR analysis showed that illness type is the most significant factor influencing the perceived burden intensity in terms of the IPOS total and subscale scores of physical symptoms, emotional symptoms and communication/practical issues. Demographic characteristics such as age, gender, marital status and co-residing status were also identified as influential factors of various symptom categories. However, patients' educational level and relationship with primary caregiver did not significantly influence any perceived symptom burden. CONCLUSIONS: This study provides valuable insights into the symptom burdens experienced by diverse patient disease groups at end-stage of life. The findings highlight the major distressing symptoms of poor mobility, family anxiety, and shortness of breath. Addressing these symptoms is crucial in improving the quality of care for terminally-ill patients. Furthermore, the study identifies influential factors that can affect the perceived intensity of symptom burden, primarily the main type of terminal illness and patient's age. Tailored care support and improved clinical care should be implemented, particularly for high-risk groups such as patients with non-cancer terminal illnesses and older aged patients. These findings contribute to existing literature and emphasize the need for comprehensive and individualized care in EoLC.

Assessment of Quality of Life among Terminally Ill Cancer Patients Receiving Palliative Care at Hospice Centre, Ahmedabad City, India.

Background: Cancer has been the leading cause of death worldwide, and palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with life-threatening illness. Hospice care helps patients and their family to cope with the change from treating the cancer to living life as fully as possible through their final days. This study aimed to (1) assess the sociodemographic and clinical profile of terminally ill cancer patients, (2) assess the QoL among terminally ill cancer patients receiving palliative care, and (3) study various determinants affecting their QoL. Material and Methods: A cross-sectional study was conducted among terminally ill cancer patients receiving palliative care at the Hospice Centre, Community Oncology Centre, Ahmedabad. Based on previous years' admission data, a sample size of 360 was taken. Patients who are seriously ill up to the extent that they were unable to respond and had a previous positive history of psychiatric illness before the diagnosis of cancer were excluded. Institutional ethical committee (IEC) permission was obtained before the study. Statistical analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) software. Results: The mean age of participants was 48.1 ± 13.0 years. The gender distribution of participants was males and females (226 (62.8%) and 134 (37.2%)), respectively. On studying, the involvement of various anatomical sites as "primary site of cancer" revealed that head and neck carcinoma had the highest (63.3%) involvement and hematological cancer had the lowest (0.6%) involvement. Of total, 62% of participants had "below-average QoL," followed by 34.9% of participants having "significantly poor QoL." There was a significant association between different age groups, time lag in cancer diagnosis, and treatment initiation and QoL. Conclusion: Spearman's rank correlations between the majority of factors fell in "low partially positive" category except for the physical well-being (factor 2) and psychosocial well-being (factor 3) with optimism and belief (factor 7), where they were in "low partially negative" category.

Undergraduate nursing students' experiences of palliative care in the intensive care unit.

BACKGROUND: The terminal ill patients in the Intensive Care Unit had physical, mental, social, and spiritual suffering. Nursing students must be aware of own feelings to be able to deliver humanistic care and enable patients to live the rest of lives with dignity. The aim of the study was to investigate experiences of providing palliative care in the Intensive Care Unit (ICU). METHOD: This study is a qualitative case study research. In-depth interviews were conducted with the key informants. The key informants were nine Thai third-year nursing students were purposively selected. RESULTS: The experiences of providing palliative care involved two Themes: (1) self-perception while providing care for terminal ill patients and (2) providing care for terminal ill patients with respect in the patients' dignity. CONCLUSION: These results can be applied to create learning activities to promote nursing students' self-awareness and enable them to provide humanized care for terminal ill patients.

Death Anxiety and Associated Factors Among Oncology Nurses and Physicians.

Background: Providing care for dying patients is a stress-inducing, complicated, as well as essential responsibility for health care providers. Furthermore, end-of-life care is associated with intense personal emotions such as grief, anxiety, depression, frustration, and guilt. Moreover, caring for terminally ill patients is a challenging task that confronts physicians and nurses with the psychological concerns of dealing with death, which is accompanied by a high level of physical and psychological discomfort.Objective: This study was aimed to measure the level of death anxiety among oncology nurses and physicians and to determine the associated factors that influence their level of death anxiety.Method: A cross-sectional descriptive design was used to guide this study, a non-probability convenience sampling method was used to recruit 200 oncology nurses and physicians from one specialized cancer center in Jordan. Data were collected using an electronic self-reported questionnaire include demographic data sheet and Collett-Lester fear of death scale, as well as all participants were invited via email for voluntary participation in this study.Result: The results revealed that the oncology nurses and physicians exhibited a moderate levels of death anxiety (CLDFODS = 91.07), furthermore, the result showed that female nurses and physicians exhibited a higher level of anxiety than male. Further, there were statistically significant differences in nurses' and physicians' level of death anxiety according to years of experience, receiving previous education on death and dying, and religious beliefs. On the other hand, there is no statistically significant differences in nurses' and physicians' level of death anxiety based on present or previous experience with loss of someone close to them.Conclusion: Jordanian oncology Nurses and physicians exhibited a moderate levels of death anxiety and fear of death, therefore, they have to address the inevitability of mortality since they are caring for dying patients frequently. They have to understand and acknowledge their thoughts regarding death and dying, as well as their death anxiety level before interacting with dying patients.

Sedação paliativa terminal no Brasil: revisão integrativa da literatura / Palliative sedation in Brazil: an integrative literature review / Sedación paliativa terminal en Brasil: revisión integradora de la literatura

Resumo A sedação paliativa está inserida no amplo espectro de práticas e condutas dos cuidados paliativos. Seu objetivo principal não é adiantar o fim da vida, mas sim prover conforto e alívio dos sintomas em uma condição de vida terminal. A prática diverge opiniões tanto no ambiente acadêmico e profissional quanto no social e religioso. Como objetivo, esta revisão integrativa da literatura buscou discussões e pesquisas mais pertinentes no cenário brasileiro, a fim de contribuir para a construção de uma noção mais atualizada e adequada ao contexto contemporâneo quanto à sedação paliativa. Questões como surgimento, opinião de médicos e estudantes, fatores bioéticos e desafios quanto à aplicação compõem a discussão da sedação paliativa na terminalidade. Todavia, a literatura disponível sobre a temática ainda é escassa, permeada de aspectos sociais, éticos, religiosos e de profissionais que demandam interpretações individuais e consenso entre as esferas sociais.

Abstract Palliative sedation integrates the broad spectrum of practices and approaches in palliative care. Its main objective is not to anticipate the end of life, but to provide comfort and symptom relief for terminal conditions; however, opinions in academic, professional, social, and religious contexts differ about its application. This integrative literature review gathers relevant discussions and research in the Brazilian context to contribute to a more updated and appropriate understanding of palliative sedation. Discussions on palliative sedation bring issues regarding its emergence, the opinions of physicians and students, bioethical factors, and challenges. However, the available literature on this topic is scarce, encompassing social, ethical, religious, and professional aspects that require individual interpretations and consensus among social spheres.

Resumen La sedación paliativa integra el amplio conjunto de prácticas y acciones de los cuidados paliativos. Su objetivo principal no es acelerar el final de la vida, sino proporcionar confort y alivio de los síntomas de los pacientes terminales. Esta práctica genera opiniones divergentes tanto en el ámbito académico y profesional como en el social y religioso. Esta revisión integradora de la literatura busca levantar las discusiones e investigaciones más pertinentes en el escenario brasileño para contribuir a la construcción de una noción más actualizada y adecuada contemporáneamente sobre sedación paliativa. El surgimiento, la opinión de médicos y estudiantes, los factores bioéticos y los desafíos en la aplicación constituyen temas de discusión sobre la sedación paliativa en el final de la vida. Sin embargo, la literatura disponible sobre este tema sigue siendo escasa, permeada de cuestiones sociales, éticas, religiosas y profesionales que requieren interpretaciones individuales y consenso entre las esferas sociales.

Accompaniment of young adults at the end-of-life: The spouse's lived experience.

PURPOSE: Studies with the spouses of young adults with cancer at the end-of-life are scarce, and it is little known how they experience care. This study aims to understand the lived experience of the phenomenon of accompaniment for young adults at end-of-life by their spouse. METHOD: This was a qualitative study, with a hermeneutic-phenomenological design, guided by the conceptual principles of Heidegger and Gadamer. Seven phenomenological interviews were carried out with spouses of young adults, whose narratives were analyzed according to the Gadamerian perspective. RESULTS: The phenomenon of accompaniment unfolded into eight topics: "Accompanying as a human commitment", "Anticipating loss", "Setting limits", "Navigating under the shadow of death through the health services", "Keeping away the shadow of death by infusing life", "Being with", "Initiating the unknown path step by step, seeking to rebuild and co-construct oneself", "The subjectivity and paradoxicality of the lived time". CONCLUSIONS: The accompaniment showed to be the most challenging lived experience for these spouses. They were faced with the threat of their partner's untimely death, which determined their expectations from institutions and health professionals. Faced with this threat, they showed to be diligent in the care of their partner, seeking to provide them with more time to live and a meaningful life. This experience was characterized by multiple losses that resulted in suffering, which left marks on the spouses that conditioned the way they saw the present and the future. These results suggest the need for a differentiated intervention to mitigate the suffering of this spouses.

Exploring the End-of-Life Experiences of Advanced Cancer Patients from India.

Objective: Paying attention to the socio-cultural characteristics of advanced cancer patients as they pass through the final stages of life can help healthcare professionals and mental health professionals assess the end-of-life experiences of terminally ill patients better. A comprehensive study of this population in the Indian context is helpful to devise individualized end-of-life care that aligns with their preferences and focuses on their comfort. Method: The dataset comprised information-rich cases of 10 advanced cancer patients from Bangalore, India, selected using the purposive sampling method. The semi-structured interviews with the participants were audio-recorded, transcribed, and translated. Identification of patterns and commonalities in the dataset helped generate codes. The codes were used to narrow down to overarching themes. Results: The standout themes were outlook on life, unfulfilled goals, end-of-life expectations, and death anxieties and attitudes to impending death. Significance of Results: The study highlights the psychosocial and cultural needs of the patients in end-of-life care. How advanced cancer patients long for psychological care from mental health professionals and empathy from their loved ones. This study argues for renewed attention on the socio-cultural characteristics of terminally ill patients to enhance individualized care through culturally-competent interventions.

Acupuncture as a tool to reduce nausea in terminally ill patients.

AIM: To investigate if acupuncture reduces nausea and vomiting in terminally ill patients. DESIGN: A comparative effectiveness research design was used to generate evidence-based knowledge close to practice for the use of clinicians. The sample size was calculated to 136 patients randomised into an intervention and a control group, respectively. Nausea and vomiting were measured using the EORTC QLQ-c15-PAL (European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire, core 15, Palliation). LOCATION: The trial was conducted among terminally ill patients admitted to three in-bed hospices in Demark. PARTICIPANTS: Terminally ill patients suffering from nausea and/or vomiting; 95% of patients had cancer. INTERVENTION: The intervention group received acupuncture in addition to usual care for three days. We used the acupuncture spots: Pericardium-6, Stomach-36, Liver-3 and Yin Tang. The control group received usual care only. RESULTS: In total, 136 patients were randomised, 24 patients withdrew resulting in a total sample of 112 patients: 52 patients in the intervention group and 60 patients in the control group. In the intervention group, 75% of the patients experienced a reduction of their nausea score after the intervention compared to 55% in the control group. The statistical difference was p = 0.028. In the intervention group, 52% of the patients did not experience nausea at all after the intervention compared to 30% in the control group. In the intervention group, 31% of the patients were still vomiting after the intervention compared to 34% in the control group; no statistically significant difference was found. CONCLUSION: Acupuncture reduced the experience of nausea among terminally ill patients but did not reduce vomiting. Thus, acupuncture is recommended to reduce nausea among terminally ill patients.

Impact of Caring for Terminally Ill Children on Physicians: A Systematic Scoping Review.

INTRODUCTION: Caring for terminally ill children influences nurses' and allied health provider's quality of life, ability to provide personalized, dignified and empathetic care and even their concepts of personhood. In the absence of data this review utilizes the Ring Theory of Personhood (RToP) to evaluate how a physician's concept of personhood is affected caring for terminally ill children in order to better support them holistically. METHODS: Using PRISMA Guidelines, 14 researchers carried out independent searches of PubMed, CINAHL, PsycINFO, Cochrane Library and gray literature databases for articles published between 2000 to 2019. Concurrent and independent employment of content and thematic analysis (Split Approach) was used to enhance the trustworthiness of the analysis. RESULTS: 13,424 titles and abstracts were retrieved, 188 full texts were evaluated, and 39 articles were included and analyzed. Identical categories and themes identified using the Split Approach suggest that caring for dying children in PPC impacts the physician's professional identity, clinical decision making, personal well-being and relationships. The data also suggests that the magnitude of these effects depends on the presence of protective and risk factors. CONCLUSION: Aside from providing a novel insight into the upon the physician, this review proffers a unique approach to accounting for the presence, magnitude and influence of incoming catalysts, resultant conflicts, and protective and risk factors upon the physician's personhood. Further studies into the changes in personhood are required. Design of a personalized assessment tool based on the RToP will help direct timely, appropriate and personalized support to these physicians.

Adolescents with Terminal Cancer: Making Good Use of Illusions.

The terminal stage of disease in teenagers is extremely complex to manage. In this study, we share some stories of terminally ill adolescent patients who made use of illusion as a way to overcome their anguish in their final stages of illness. These experiences show how young patients can cope better with terminal illness by resorting to a nonrational and fictional dimension that can serve them as a psychological compromise, helping them tolerate their real everyday life by suspending their critical senses for a while. Illusions can serve as a resource for young patients and a potentially useful tool for medical professionals.

Satisfação dos familiares de pacientes críticos admitidos em unidade de terapia intensiva de hospital público e fatores correlacionados / Satisfaction of family members of critically ill patients admitted to a public hospital intensive care unit and correlated factors

RESUMO Objetivo: Analisar a satisfação, a compreensão e os sintomas de ansiedade e depressão em familiares de pacientes admitidos na unidade de terapia intensiva. Métodos: O familiar do paciente com tempo de internação ≥ 72 horas foi convidado a participar do estudo, realizado em um hospital público. Foram respondidos questionários para avaliar a compreensão do diagnóstico, do tratamento e do prognóstico, e o suporte recebido na unidade de terapia intensiva. Também foram avaliadas as necessidades da família por meio da versão modificada do Critical Care Family Needs Inventory (CCFNI) e foi aplicada a Hospital Anxiety and Depression Scale (HADS), para avaliar os sintomas de ansiedade e depressão. Resultados: Foram entrevistados 35 familiares em sua primeira semana de permanência na unidade de terapia intensiva. A maioria dos pacientes (57,1%) era do sexo masculino, com 54 ± 19 anos de idade. A sepse foi o principal motivo da internação na unidade de terapia intensiva (40%); a mediana do Simplified Acute Physiology Score (SAPS) 3 foi de 68 (48 - 77) e 51,4% faleceram na unidade de terapia intensiva. A maioria dos familiares era do sexo feminino (74,3%), filhos ou filhas dos pacientes (54,3%), com idade de 43,2 ± 14 anos. Foi observado que 77,1% dos familiares encontravam-se satisfeitos com a unidade de terapia intensiva. A incompreensão do prognóstico foi observada em 37,1% dos familiares. As informações claras e completas recebidas na unidade de terapia intensiva e o médico ser acessível tiveram correlação significativa com a satisfação geral da família. Foi grande a prevalência dos sintomas de ansiedade (60%) e depressão em (54,3%) nos familiares. Conclusão: O sofrimento emocional dos familiares é grande durante a internação do paciente na unidade de terapia intensiva, embora a satisfação seja alta. As informações claras e completas dadas pelo intensivista e o suporte recebido na unidade de terapia intensiva têm correlação significativa com a satisfação dos familiares em um hospital público.

ABSTRACT Objective: To analyze the satisfaction, medical situation understanding and symptoms of anxiety and depression in family members of patients admitted to the intensive care unit. Methods: The family members of patients who were hospitalized for ≥ 72 hours were invited to participate in the study, which was performed in a public hospital. Questionnaires were answered to assess the understanding of the diagnosis, treatment and prognosis, and the support received in the intensive care unit. The family needs were also evaluated using a modified version of the Critical Care Family Needs Inventory (CCFNI). The Hospital Anxiety and Depression Scale (HADS) was used to assess the symptoms of anxiety and depression. Results: A total of 35 family members were interviewed within the patients' first week of stay in the intensive care unit. Most patients (57.1%) were male, aged 54 ± 19 years. Sepsis was the main reason for admission to the intensive care unit (40%); the median of the Simplified Acute Physiology Score (SAPS) 3 was 68 (48 - 77), and 51.4% of the patients died in the intensive care unit. The majority of the family members were female (74.3%) and were sons or daughters of patients (54.3%), with a mean age of 43.2 ± 14 years. Overall, 77.1% of the family members were satisfied with the intensive care unit. A total of 37.1% of the family members did not understand the prognosis. Receiving clear and complete information in the intensive care unit and the doctor being accessible were factors that were significantly correlated with the overall family satisfaction. The prevalence of symptoms of anxiety (60%) and depression (54.3%) in the family members was high. Conclusion: The emotional distress of family members is high during a patient's hospitalization in the intensive care unit, although satisfaction is also high. Clear and complete information provided by the intensivist and the support received in the intensive care unit are significantly correlated with the satisfaction of family members in a public hospital.

[Using an Innovative Portable Shower Bed to Improve Current Bathing Methods and Enhance the Physical Comfort of Terminally Ill Patients in Home Environments].

BACKGROUND & PROBLEMS: Terminally ill patients frequently suffer from physical distress and a limited ability to perform activities of daily living. Bathing is a particularly troublesome problem for these patients, as the limitations of the home environment increase the challenges for caregivers to bathe terminally ill patients at home. PURPOSE: This study was developed to alter the current bathing methods of terminally ill patients in order to improve their physical comfort and to help caregivers better facilitate home-bathing care for their patients. RESOLUTIONS: A "portable shower bed" was introduced to allow patients to bathe in their own beds. The tools used to evaluate results were the Bathing and Physical Comfort Scale and the self-developed Bathing Satisfaction Questionnaire. RESULTS: A total of 90% of participants expressed satisfaction with the portable shower bed. Furthermore, the average physical comfort score of participants improved from 3.9 to 6.13. CONCLUSION: The innovative portable shower bed is inexpensive, practical, foldable, easy to operate, safe, and comfortable. The bed significantly reduces the difficulties faced by caregivers in helping terminally ill patients bathe in home environments. This shower bed reduces the burden on caregivers by improving bathing care and the physical comfort of terminally ill patients.

Predictive Factors for Short-term Mortality in Terminal Cancer Patients Who Visit an Emergency Department

PURPOSE: Although some predictive tools are widely used for the prognostic assessment of terminal cancer patients in hospice-palliative care units, it remains unclear which factors predict survival of terminal cancer patients presenting at an emergency department (ED). The aim of this study was to find predictive factors for 1 week and 1 month mortality in ED patients with terminal cancer. METHODS: We conducted a prospective study on patients with terminal cancer who visited the ED. Patient data included demographics, clinical symptoms and signs, severity scales, and laboratory test results. We estimated differences in survival rate at 1 week and 1 month using Cox-proportional regression analysis. For those variables that were significant, we did multivariate analysis. RESULTS: One hundred and ten patients were enrolled. The median survival duration was 10 days. Univariate analysis showed that tachypnea, tachycardia, hypotension, cognitive dysfunction and acute renal dysfunction were statistically significant predictors of mortality. The Eastern Cooperative Oncology Group score, the Sequential Organ Failure Assessment score, leukocyte and neutrophil counts, serum levels of C-reactive protein (CRP), blood urea nitrogen (BUN), creatinine and sodium were also predictors of mortality. Multivariate analysis showed that hypotension and serum levels of CRP, BUN and sodium were independent predictors. CONCLUSION: In ED patients with terminal cancer, hypotension and serum levels of CRP, BUN and sodium may be useful for predicting 1 week and 1 month mortality.

Terminalidade e cuidados paliativos na unidade de terapia intensiva: [revisão] / End of life and palliative care in intensive care unit: [review]

O objetivo da presente revisão foi avaliar o estado atual do conhecimento sobre doença terminal e cuidados paliativos em unidade de terapia intensiva. Identificar as questões-chave e sugerir uma agenda de pesquisa sobre essas questões. A Associação Brasileira de Medicina Intensiva organizou um fórum especifico para o debate de doenças terminais na unidade de terapia intensiva, onde participaram profissionais experientes em medicina intensiva. Esses profissionais foram subdivididos em 3 subgrupos, que discutiram: comunicação em unidade de terapia intensiva, decisões diante de um doente terminal e cuidados/ações paliativas na unidade de terapia intensiva. As informações e referências bibliográficas foram copiladas e trabalhadas através de um site de acesso restrito. Os trabalhos ocorreram em 12 horas quando foram realizadas discussões sistematizadas seguindo o método Delphi modificado. Foram elaboradas definições sobre a terminalidade. A adequada comunicação foi considerada de primordial importância para a condução do tratamento de um paciente terminal. Foram descritas barreiras de comunicação que devem ser evitadas sendo definidas técnicas para a boa comunicação. Foram também definidos os critérios para cuidados e ações paliativas nas unidades de terapia intensiva, sendo considerada fundamental a aceitação da morte, como um evento natural, e o respeito à autonomia e não maleficência do paciente. Considerou-se aconselhável a suspensão de medicamentos fúteis, que prolonguem o morrer e a adequação dos tratamentos não fúteis privilegiando o controle da dor e dos sintomas para o alívio do sofrimento dos pacientes com doença terminal. Para a prestação de cuidados paliativos a pacientes críticos e seus familiares, devem ser seguidos princípios e metas que visem o respeito às necessidades e anseios individuais. Os profissionais da unidade de terapia intensiva envolvidos com o tratamento desses pacientes são submetidos a grande estresse e tensão...

The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.