Even when a person has been living with a terminal illness for a while, it can be a shock for them and their loved ones when they reach the last days of their life. Health professionals should talk to the person and those who are most important to them about what’s happening, to help them prepare for their death and address their concerns.
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Key points
- Even when a person has been living with a terminal illness for a while, it can be a shock for them and their loved ones when they reach the last days of their life.
- It’s important to tell someone that they’re dying so that they and their loved ones can prepare and make the most of the time they have left.
- An experienced health professional who knows the person well and whom the person trusts is the best person to tell them.
- If you don’t feel comfortable having these conversations, ask a more experienced colleague for help.
Why is it important to tell someone that they’re dying?
It’s important to tell someone that they’re dying so they can prepare and do what’s most important to them. If the person consents, you should tell the people who are close to them as well, such as partners, friends and family members. This can allow them to make the most of the time they have left. For example, they can focus on:
- people they want to see
- resolving any conflict or other unfinished business
- discussing what they want from their care – this is often called advance care planning
- talking about where they’d prefer to be cared for
- making decisions about any treatments to manage their symptoms
- making decisions about any treatments they don’t want, for example resuscitation (CPR)
- cultural, religious, social or spiritual practices that are important to them
- planning their funeral
- making or updating a Will.
How do I know that someone is dying?
It can be difficult to know when a person is reaching the last few days of their life – everyone’s experience of dying is different. There are some common signs that can help you to recognise when someone is entering this phase.
How should I tell someone that they’re dying?
You should prepare for this conversation so that it can be done in the most sensitive way. If you don’t feel comfortable having this conversation, ask a more experienced colleague for help.
There are things you can do to support the person who is dying and those around them. These include:
- Make sure you have enough time so that the conversation won’t be rushed.
- If possible, have the conversation in a place that’s comfortable for the person and where you won’t be interrupted.
- Ask the person if they would like anyone else to be there. This could be a family member, carer or friend. They can support the person and help to check that they’ve understood what they’re being told.
- Use clear language. Avoid euphemisms such as ‘going to a better place’. Using the word ‘dying’ where appropriate can avoid confusion.
- If someone has difficulty communicating, there are things you can do to support them. We have more information on supporting people with communication difficulties.
- Check that they’ve understood what you’ve told them.
- Allow them to ask any questions. If you don’t know the answer, be honest and say you don’t know. You can try and find out and let them know as soon as possible.
- You do not have to cover everything in one conversation. Let them know that you can continue to talk about it at another time.
Who should tell them?
The best person to speak to someone who is dying and those important to them is a health professional who is confident and experienced and has a good rapport with the person. This is often the person’s GP or specialist nurse.
When should they be told?
If someone has signs that they are approaching the end of their life, this is a good time to speak to them. It’s not possible to tell exactly how long someone will live for but there are some signs that make it more likely that someone is in their last few weeks, days and hours.
If they want to know how long they have left, it’s important not to make any specific predictions. It’s very difficult to predict how long a person is going to continue to live for and getting it wrong can be very distressing for them and their loved ones. Speaking in terms of weeks, days or hours can be helpful. For example, when someone is deteriorating from week to week, they may have weeks left. When they deteriorate day by day, they may have days left. But everyone is different.
You may find it helpful to share our information about the dying process for people with a terminal illness and those important to them (see the links below).
What can I do to support them?
Whatever your role, there are things you can do to help someone cope with being told they are dying. This includes letting them know you are available to talk.
If someone wants to talk about dying, they might struggle to find the words to start the conversation. The person or their family and friends might give you some cues that they’re thinking about it. For example, they might talk about:
- feeling more unwell
- making the most of the time that they have left
- what happens to their body after they die
- spiritual and religious practices that are important to them.
You can respond to these cues and start a conversation about dying. If the person doesn’t want to say anything else at that time, don’t force the conversation. You can let them know that you’re ready to talk about it if they want to come back to it at another time. You can also tell the person’s GP or specialist nurse that they are thinking about these things so that they can continue the conversation and address any concerns.
Keep the dying person at the centre of every decision to ensure their needs and preferences are met as much as possible.
Find out how much the dying person wishes to be involved in making decisions about their care. Ask if they would like someone else to be present at any important conversations with health and social care professionals. If someone lacks mental capacity to make decisions, find out if they have an advance care plan in place so you can follow their wishes. This might include an advance statement where they record their wishes for the care that they receive or an Advance Decision to Refuse Treatment (called Advance Directive in Scotland).
When should I ask for help?
If you’re not trained or don’t feel experienced enough to tell someone that they’re dying, ask a more experienced colleague for help. This could be the person’s GP, specialist nurse, hospital doctor or other professional. It’s best if it’s someone who’s knows the person’s history and whom the person trusts.
If you’re unsure if someone is entering the last days of their life, ask someone with more experience to be involved too.
Taking care of yourself
Talking about dying can be challenging for you as well. It may trigger memories of people you have lost or care about in your personal life. This is normal but if your feelings are interfering with your work or personal life, it is a good idea to get some support. Talking to your manager or other colleagues about your experiences can be helpful. If you feel you need extra support, you could consider seeing a counsellor or psychologist.
Talking about dying is a skill that can be learned and improved. Reflect on your conversations and think about what went well and what you could do better next time. Ask your manager if there are any communication skills courses you could attend.