Defining and Managing End-of-Life Respiratory Changes in Adult Home Hospice Patients: A Systematic Review

Background: End-of-life respiratory changes-agonal breathing, Cheyne-Stokes breathing, and death rattle/noisy breathing-are common in home hospice settings, impacting patient comfort, caregiver distress, and quality of care. Purpose: To identify and critically evaluate literature on definitions, characteristics, and management for end-of-life respiratory changes in home hospice patients. Data Sources: English-language articles in Ovid Medline, Scopus, CINAHL, APA PsycINFO, and Web of Science published before April 18, 2024. Study Selection: 9 peer-reviewed articles (comprising two nonrandomized experimental studies, two case reports, a cohort study, a cross-sectional study, a review, a text and opinion article, and a combined case report with personal reflection) involving adults in home hospice or palliative care and included definitions, characteristics, or treatments of agonal breathing, Cheyne-Stokes breathing, or death rattle/noisy breathing. Data Extraction: Two independent reviewers extracted data on study characteristics, respiratory change definitions/characteristics, distress to patients and care providers, and treatments. Data Synthesis: Most studies were recent (2014 or later) and conducted in the United States. Agonal breathing was defined as reflexive gasping and sighing respirations. Cheyne-Stoke's breathing was mentioned without detailed descriptions. Death rattle/noisy breathing was characterized by loud secretions. Distress was evident for care providers, not patients. Treatment included anticholinergics for death rattle/noisy breathing, showing limited efficacy, and nonpharmacological approaches such as caregiver education and patient positioning. Limitations: Few studies included, encompassing various report types. Conclusions: There is a dearth of evidence on respiratory changes, particularly agonal breathing and Cheyne-Stokes breathing, in home hospice patients. Definitions and treatment guidelines vary, emphasizing the need for clear, evidence-based protocols. Improved caregiver education and future research are crucial to enhancing end-of-life care in home hospice settings.