Fast Fact and Concept #118: Near Death Awareness

Author(s): Marchand, Lucille

Near death awareness (NDA) is a term to describe a dying person's experiences of the dying process. Information comes from broadly reported anecdotes. Patients appear to describe what dying is like and what they need for a peaceful death. The language patients use to communicate NDA may be symbolic. If caretakers are not aware that NDA can occur, patients may be treated condescendingly, ignored or inappropriately medicated for delirium. Family, friends, and health professionals may respond with annoyance, frustration or fear. This, in turn, may cause isolation, suffering, and impair the dying person's ability to communicate meaningful experiences at the end of life.

The distinction between NDA and delirium can be difficult; NDA communications, such as reports of patients seeing and speaking to dead relatives, can be misinterpreted as delirium. Delirium presents with deficits in orientation, attention, and short-term memory and should be assessed carefully and treated appropriately.

The recognition of NDA requires attentive listening. Health professionals, family, friends and caregivers can help decipher NDA messages. Two broad categories of messages have been described :

1. Attempts to describe what dying is like:

• Communicating with or experiencing the presence of someone who is not alive
• Preparing for travel or a change
• Describing a place they can see in another realm
• Knowing when death will occur

2. Requests for something to ensure a peaceful death:

• Achieve closure in a personal or spiritual relationship, or in an ethical matter
• Remove a barrier to achieving closure
• Prepare for death via specific items or rituals

Pearls for Listening for NDA Phenomena

• Evaluate for causes of delirium and treat when appropriate. Be careful to evaluate for agitation arising from a message not being understood or addressed.
• Gently ask patient about messages you don't understand.
• Accept and validate what the patient is telling you; don't challenge or argue.
• Be honest when you don't understand, but let patient know you will keep trying.
• If you don't know what to say, say nothing, but be present.

Health Professional Responses to NDA Phenomena:

• Help the patient find closure, relieve suffering and anxiety, and help the patient achieve a peaceful, fulfilling death.
• Help families, friends and health professionals gain comfort and important knowledge about dying.
• Lessen our own fears about dying.

Note: see the following references for clinical examples. Examples in the Callahan and Kelley text provide guidance for caretakers on how to help patients who are experiencing NDA.

References:

1. Callahan, M and Kelley, P. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying. Bantam Books: 1992
2. Moody, R. Life after Life. Bantam Books: 1975.
3. Greenberg, D. Preventing Delirium at End of Life: Lessons from Recent Research. Primary Care Companion. J Clin Psychiatry 2003; 5(2): 62-67.

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Marchand L. Fast Facts and Concepts #118: Near death awareness. August 2004. End-of-Life/Palliative Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is use.

Creation Date: 8/2004

Purpose: Instructional Aid, Self-Study Guide, Teaching

Audience(s)

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Non pain symptoms & syndromes; psychosocial and spiritual experience