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Diagnosing Dying: Symptoms and Signs of End-Stage Disease
  1. Sue Haig, Clinical Nurse Specialist
  1. Hospital Palliative Care Team, Southampton University Hospitals NHS Trust, Southampton General Hospital, Southampton. Email: sue.haig{at}


After being given a terminal diagnosis, patients and their families/carers often enquire about the prognosis. However, determining individual patients’ prognoses is challenging for healthcare professionals. This article reviews the complexities of predicting prognosis and diagnosing the process of dying. It aims to improve nurses’ understanding of the dying process and to inform clinical practice across all care settings. It is essential that nurses and other members of the healthcare team recognise when the dying process is beginning, so that the patient, family members and carers can be informed. The key issues in relation to determining prognosis are diagnosis, the individual’s performance status and the increase of symptom burden and disease progression. The article discusses disease trajectories associated with specific conditions, the common signs and symptoms of the dying phase and common clinical indicators that are found at the very end of life and which suggest that a patient is beginning to die. Conflicts of interest: none

  • Dying
  • Last 48 hours
  • Palliative and end-of-life care
  • Prognosis
  • Symptom burden

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