Terminal patients' awareness of impending death: the impact upon requesting adequate care

In this qualitative study, 19 Dutch terminal patients and 23 relatives of deceased patients were interviewed. The interviews revealed that a timely request for care and anticipation of "what was going to happen" was determined by the degree to which patients and their relatives realize that the end of life was close, that the symptoms would get worse, and that the family would have to bear an increasing burden. When awareness of the severity of the situation dawns late, shortly before death, the patient and family may not receive the right sort of care, nor have access to the appropriate facilities. In the concluding part of this article, there is a plea for adopting a proactive approach. Nurses and other caregivers must try to prepare patients and relatives early for the care that will become necessary in the later stages.