The Impact of "Death Rattle" on Patients, Informal Caregivers and Healthcare Professionals: A Scoping Review

BackgroundAudible upper airway secretions ("death rattle") is a common problem in patients in the last days of life. The objectives of this scoping review was to determine the impact of death rattle on patients, informal caregivers, and healthcare professionals.MethodsThe scoping review used standard methods, and involved searching Medline (Ovid), Embase, CINAHL, PsycInfo, and the Cochrane Library. Studies were included if they reported original data on the impact of death rattle on 1 or more of the specified populations. Hand searching was also undertaken to identify further studies.ResultsFourteen original studies were identified: 2 studies focused on patients, 7 on informal caregivers, and 5 on healthcare professionals. The impact of death rattle was somewhat variable, although related distress was common amongst informal carers, and also amongst healthcare professionals. The impact of death rattle on patients was less well described, although there was a consensus that death rattle is not distressing to affected patients (but may be distressing to other patients). Various beliefs were associated with distress amongst informal carers, and these may be amenable to educational interventions about the nature of death rattle.ConclusionDeath rattle is frequently distressing, and strategies need to be developed to mitigate the distress experienced by informal carers, and equally healthcare professionals. Further research is needed to determine the effect on patients experiencing the problem, and also patients witnessing the problem.