Prevalence and management of symptoms during the last month of life

Background: The prevalence and severity of the "most troublesome" symptoms in terminally ill patients are well known and have been studied in many settings. However, these symptoms change during the course of advanced disease. Objectives: To evaluate the range and trajectory of symptoms in the final stage of life as measured a month prior to death. Methods: Patients with an expected prognosis of less than 6 months were recruited for the study. Excluded were non-Hebrew or Russian speakers, and patients with cognitive impairment or a diagnosis of brain tumor. A structured questionnaire was used to interview patients and their caregivers at home every 2 weeks until death. We present a comparison analysis of 45 patients who completed both interviews 2 and 4 weeks before death. Results: There were five symptoms (fatigue, pain, reduced wellbeing, lack of appetite, somnolence) that were reported most frequently, occurring in more than 70% of the patients. Most of the symptoms showed a worsening trend towards death. Conclusions: Assessing the presence and severity of symptoms as a guide to start or modify treatment is recommended. Knowledge of how symptoms change in the final stage of life could better assist in the management of resources and could help patients and their families in their final preparations.