Lifetime assessment in palliative patients is of paramount importance for family and caregivers to organise the best possible care. Research about prediction of death with objectively observable signs in a prospective way and/or multicenter studies is scarce.
Material and methods: A prospective multicenter cohort designed study is performed in 8 palliative care units (PCU) to register 8 objective observable signs in palliative patients: cold and/or white nose, cold extremities, livid spots, cyanotic lips, death rattle, apnoea (>15 sec/minute), anuria (<300 cc/24h) and somnolence (>15h sleep/24h).
Results: The presence/absence of the 8 signs is in 685 patients registered 2x/d. during daily nursing from occurrence of 1 sign until death. Somnolence is the most prevalent sign but anuria and livid spots occurred the most early. Death rattle and apnoea appeared most close to actual death. For all these signs there was a significant increase in prevalence four days before death. The same observation is seen in all the 8 PCU.
Conclusion: Death seems to be predictable within a few days for terminal palliative patients by the observation of 8 objectively observable signs during standard nursing care. This observation seems to be reproducible in 8 PCU without any specific training of the caregivers. -These results need to be confirmed in hospital and home care settings.