The terminal phase

This chapter covers the common issues encountered in the last days of life relating to prognostication, anticipatory prescribing, common symptom management, spiritual care, and the five priorites of end-of-life care. Terminal phase is the period of inexorable and irreversible decline in functional status prior to death. It is the period when there is day-to-day deterioration, particularly of strength, appetite, and awareness. This may unfold gradually over days or weeks, or occur precipitously following an unexpected event, e.g. stroke. These challenges may present as sudden changes in the clinical status needing urgent attention. More often they are predictable, and reflect a final common pathway of many progressive illnesses.