What do we know about the dying patient? Awareness as a means to improve palliative care

With the Hospice movement palliative care has been improved in dramatic ways. But there is also evidence that although the nursing staff is aware of the medical and physical care needs, they may have insufficient knowledge about the patient as a person, which is a prerequisite for individualized patient centered care. Avery Weisman and co-workers used six questions in post-mortem sessions where the patients' terminal period was evaluated. They used the expression Psychological autopsy for this and stressed the importance of gathering information about psycho-social aspects in the end of life experience. In a hospice-related project in Sweden, Weisman's questions were transformed into the following keywords: Symptom Control, Self-determination, Social Relations, Self-image, Synthesis, and Surrender. These were used prospectively in nursing documentation as well as in follow-up sessions after death with staff and in interviews with the patients' family members. This contributed to a greater awareness of the patients' total situation at the end of life.