The majority of patients want, above all, to retain their dignity, and remain as much in control of their situation as they can. They want to know that they will not be abandoned, and that their wishes will be paramount when decisions need to be made. Because the main aim of treatment should be symptom control, only medications which will control or prevent distressing symptoms should be given. Many drugs for long-term conditions, such as antihypertensives, cardiac drugs or hypoglycaemics, can be discontinued. Approximately two thirds of terminally ill patients experience pain, whatever the underlying diagnosis.
Many people fear dying in pain almost more than death itself.
All clinicians who care for dying patients should have the skills necessary to enable pain to be controlled in the majority of patients. They must be willing to seek appropriate specialist advice and support when the pain proves complex or difficult to control. Multidisciplinary specialist palliative care teams are available for patients in both community and inpatient settings. They can offer educational input to colleagues in other specialties, and advise on the management of individual patients. As in all clinical situations, start with a careful assessment.