Last Days in the Hospital or Intensive Care Unit
Key Points for This Section
Choices about whether to use intensive care should be discussed.
Near the end of life, patients with advanced cancer may be admitted to a hospital or intensive care unit (ICU) if they have not made other choices for their care. In the ICU, patients or family members have to make hard decisions about whether to start, continue, or stop aggressive treatments that may make the patient live longer, but do not improve the patient's quality of life. Families may be unsure of their feelings or have trouble deciding whether to limit or avoid treatments.
Sometimes, treatments like dialysis or blood transfusions may be tried for a short time. However, at any time, patients or families may talk with doctors about whether they want to continue with ICU care. They may choose instead to change over to comfort care in the final days.
Ventilator use may keep the patient alive after normal breathing stops.
A ventilator is a machine that helps patients breathe. Sometimes, using a ventilator will not improve the patient's condition, but will keep the patient alive longer. If the goal of care is to help the patient live longer, a ventilator may be used, according to the patient's wishes. If ventilator support stops helping the patient or is no longer what the patient wants, the patient, family, and healthcare team may decide to turn the ventilator off.
Before a ventilator is turned off, family members will be given information about what to expect.
Family members will be given information about how the patient may respond when the ventilator is removed and about pain relief or sedation to keep the patient comfortable. Family members will be given time to contact other loved ones who wish to be there. Chaplains or social workers may be called to give help and support to the family.