The transitional phase: the closing journey for patients and family caregivers

The ability to identify physical waypoints along the continuum of illness may give end-stage patients and their families opportunities for goal reframing and risk reduction. That period which exists between active participation in the activities of daily living and a bedbound status, herein described as the transitional phase, is characterized by the four precursive, or seminal, behaviors of anorexia, increased sleep, weakness, and confusion, and the two cardinal behaviors of incontinence and falls. It is a time of heightened anxiety for families and risk of injury for patients. The ability to identify these behaviors as part of a definable phase, with a beginning and an end, allows the health care clinician or hospice worker to educate the family, assisting with goal reassignment, risk reduction, and diminishment of anxiety. Family understanding of the finite nature of the transitional phase may also reduce the need for placement outside the home for those wishing their loved one to die at home, and provide the caregiver with meaningful participation in end-of-life problem solving.