Asked and Answered

Every year our Ask a Professional Team answers hundreds of questions from Canadians on a range of palliative care topics. Now you can read through a selection of these questions and answers. See what other Canadians are experiencing and learn more about palliative care with the help of our team of experts.

Please note that personal information has been removed to protect privacy.

    Index

    How do you know when someone is ready for palliative care?
    A decision to begin palliative care takes in many factors. Ideally the decision includes a discussion with the health care team, who can offer information about options and available support. Several questions can help determine when palliative care becomes the main focus of care: What options are available for treatment? What does the person... read more...
    How is eligibility for palliative care decided? What procedure is followed?
    Decisions about palliative care must distinguish between a general palliative care approach and palliative care services, which often have limited resources. A palliative approach to care is broadly aimed at ensuring comfort and quality of life for people with a life-threatening illness. Ideally, this approach is an integral part of supporting... read more...
    Is there a cost for palliative care in the hospital?
    Canada has universal health care, which provides basic health care without user fees. Yet the provinces control health care, and some charge a fee to access the health system. Palliative care is a basic service in all provinces and territories, so there’s no charge for palliative care in a hospital. Provincial and territorial governments usually... read more...
    What are the criteria for being admitted to a hospice?
    The terms " palliative care " and "hospice" mean different things to different people. Here, "hospice" is taken to mean a facility that provides an alternative home for people living with a terminal illness. These people need a community, home-like environment and specialized care, yet their care isn’t so complex that it requires a hospital. read more...
    What funding is available for palliative care patients or caregivers?
    “One of the most difficult times for anyone is when a loved one is dying or at risk of death. The demands of caring for a gravely ill family member can jeopardize both your job and the financial security of your family. The Government of Canada believes that, during such times, you should not have to choose between keeping your job and caring... read more...
    What’s the difference between palliative care at home and palliative care at the hospital?
    Several factors determine the best place for providing care to a person with an advanced illness. This type of decision requires a balance between patient and family needs, and the availability of resources to meet those needs. Patient and family considerations include the following: patient and family preference; physical ability to manage... read more...
    My dad doesn’t talk about his illness. How can I talk to him about dying?
    Many people find it difficult to talk about death, dying and their own illness. For some people this kind of discussion is most difficult with family. You can try several strategies to help your father open up and talk. It’s possible that no matter what you try your dad may be unwilling to talk. This can be hard for you, and if it is, it may... read more...
    My friend who’s ill says he’s nearing the end, but he seems to be doing well. Is this normal?
    It’s sometimes hard to know why people respond the way they do to their illness. There could be a lot going on inside your friend that can’t be seen on the outside. He may not seem to be declining rapidly, but may feel inside that things are changing. These changes can include pain , fatigue or lack of appetite, which aren’t necessarily visible... read more...
    My husband is dying and refuses palliative care. What can I do?
    Most palliative care programs require people to accept that the programs offer a comfort-focused approach to care rather than efforts to cure the underlying illness. This is hard for many people to accept. Even if deep down they are aware of their situation, it’s hard to let go of hope for a cure. This can be frustrating and upsetting for... read more...
    My husband is nearing the end. How can I calm his fears about dying?
    It may help to start by asking your husband what his fears are. It’s important to understand them and talk about them. Some fears are about what will happen physically. These fears may be eased if he understands what’s ahead, and what the health care team can do for him in his final days. Other fears may be more spiritual or emotional, as... read more...
    My mom has a lot of pain and is breaking down emotionally. She says she wants to die. I don't know how to help her. What can I do?
    It can be very hard to watch someone suffer. Physical, emotional and spiritual suffering are intertwined, and they affect each other. All aspects of suffering need to be acknowledged and addressed. Your mom’s pain is likely a major factor in the distress she’s feeling. It may be this pain that’s making her say she wants to die. Pain can be... read more...
    What can I do to support my wife who’s dying and let her know she won’t be forgotten?
    Your presence and support is the greatest gift you can give your wife. This time can offer you both a chance to talk about things that matter to you. You may want to talk about memorable moments in your lives, share stories about people, or review important events. Let your wife know the positive effect she’s had on you. Encourage family and... read more...
    What can I say to a friend who is dying?
    It’s normal to feel anxious about visiting someone who is dying. Our society discourages talk about death, dying and illness, and few of us have much experience with it. It’s important to remember that even though your friend is dying, she’s still the same person you’ve always known. She’d likely prefer that you treat her as you always have. read more...
    My husband often vents his frustration and anger towards me. I know he is very ill and things aren’t going well, but how can I respond?
    This is a difficult and yet very common experience of caregivers. When someone is not well, they often take out their frustrations and anger on the person who is closest to them. Perhaps they feel it is a safe place to “just be themselves.” In terms of how to respond, it’s important to recognize that anger is a natural and powerful emotion... read more...
    I am wondering how to tell my aunt with dementia that her husband has died?
    Telling someone about the death of a family member is difficult for most people, but it is even more challenging when the person you have to tell has dementia. Your approach will depend on the extent of the person's disease, where the person is at and how much they remember. Often the first thought is to try to protect the person with dementia... read more...
    I live far from a friend who’s caring for his dying father. How can I be supportive from a distance?
    Your friend most likely needs to talk about his feelings and frustrations. Listening may be the support he needs the most. Consider offering to call regularly to check in. Ask what time is best to call, as he likely has a schedule that needs to be kept. Also ask how often he’d like you to call. He may be busy, and can only manage one call... read more...
    My friend’s mother is dying. What can I say to her family?
    Few of us have much experience talking about death and dying. It’s normal to be afraid of saying the wrong thing and upsetting someone. If we don’t know what to say, we often don’t say anything and avoid the whole situation. This may be why families of people who are dying notice that friends no longer call or visit. Yet, the time when people... read more...
    My wife has terminal cancer. My daughter has been visiting and is creating additional emotional stress for us. I would like to talk to my daughter, but she is always on the defensive. My daughter was supposed to be here to help her mother emotionally, but she only seems concerned with her own trivial issues. What can I do?
    Living with a loved one who has a progressive cancer disease is stressful and exhausting. It affects each family member differently, and everyone has his or her own reaction. Often, the way we respond to one another becomes more intense as the stress of the situation increases. Your daughter’s behaviour, which may appear defensive and self-focused,... read more...
    How do I tell my young son that his grandmother is dying of cancer?
    It’s very important to talk with children honestly about illness and death. Children can sense when something’s wrong and may worry more if no one talks to them openly about it. Explain to your son in simple terms what’s happening with his grandmother. Tell him that she won’t be getting better. Don’t be afraid to use the words "cancer, " "death"... read more...
    How do we help our adult children feel comfortable with their dying father and his right to die with dignity?
    It’s not surprising that we have trouble finding the best way to talk and think about death when we face it in our own lives. Few of us have gone through it or seen others go through it. Some general concepts can help people and families find the approach that suits them the best. It’s important to remember that there’s no one right or wrong... read more...
    Should my young son attend the funeral of his grandmother?
    Research suggests that children should go to funerals if they want to. It gives children a chance to see grief and learn about it. If your son will attend a service, talk with him ahead of time about what he can expect. For example, if there will be an open casket, let him know he will be seeing his grandmother’s body. He may have many questions,... read more...
    What should I say to my children about death and cremation?
    Discussion with children about death and the rituals around death need to be honest and open. Children need this because they can sense what’s going on around them. Honest answers to their questions can minimize their fears. Before you discuss cremation, talk about death in simple terms. You may say that death means someone is no longer breathing,... read more...
    A friend has been diagnosed with a life-limiting illness. We’re not really close, but we get along well. Is it appropriate to reach out to her? How should I do that?
    If you feel that you’d like to be in touch, we encourage you to do so. You know best what fits for you and your friend: an email message, a phone call, a card or a gift, such as a book, a small plant or a bouquet of flowers. If you decide to write or talk to her, you may be worried about what to say. Sometimes, the best place to start is by... read more...
    My wife is dying. What do I say to people who ask how we’re doing?
    It may be that you're having good days and bad days, and it's very hard for anyone else to understand fully what that's like. This may be hard to express, but it's worth trying to let others know. People usually ask “How are you doing? " out of habit or courtesy. When they ask this, feel free to tell them. Your response may stop conversation... read more...
    My father’s been diagnosed with cancer and we’re having a hard time getting specific answers. What can we expect for a prognosis?
    Misunderstandings are common when terminal illness and prognosis are discussed. Most people, including some healthcare providers, are uncomfortable with the subject. Because of this, or because they want to prevent distress, health providers may use vague terms that are open to interpretation. Two people can be using the same words, but be... read more...
    My grandmother has cancer and refuses to discuss the fact that she hasn’t responded to treatment. She tells her physician she’s doing fine and refuses to deal with her situation. How can I deal with that? Should I contact her physician?
    It’s common that people with progressive illnesses want to avoid certain facts. It’s especially common if they’re not responding to treatment or if their health is declining. In your grandmother’s case she may be ignoring her situation because she can’t cope, or she may be saying what she thinks her health care providers want to hear. It can... read more...
    When I enter hospice, will I have any control over how much pain relief I can get? Will I be putting my doctor in a bad position by asking how much morphine would cause my death?
    Your current situation must seem overwhelming. So it’s natural to want to take control. In hospice, you can have a lot of control over your own health care. Before you enter hospice, it’s a good idea to meet with your health care team. They are the doctors and nurses who will provide your care. Review how you are feeling now and what might... read more...
    How detailed should a health care directive be?
    A health care directive is a document that describes the treatment decisions that a person wants made in the future. It’s used to guide care if the patient can’t communicate in any other way at when a decision has to be made. A person needs to consider what others will need to know about his or her wishes. These wishes can be general or specific. read more...
    How is the decision made as to whether to continue with radiation treatments?
    Several factors are taken into account when deciding whether to continue radiation treatments: the wishes of the person who’s ill; the amount of radiation already delivered to the target area; the overall strength and energy of the person who’s ill. Patient’s wishes The main consideration is what the patient wants. If the person doesn’t want... read more...
    When I enter hospice, will I have any control over how much pain relief I can get? Will I be putting my doctor in a bad position by asking how much morphine would cause my death?
    Your current situation must seem overwhelming. So it’s natural to want to take control. In hospice, you can have a lot of control over your own health care. Before you enter hospice, it’s a good idea to meet with your health care team. They are the doctors and nurses who will provide your care. Review how you are feeling now and what might... read more...
    When is the right time to discontinue life support?
    Discontinuing life support is one of the most difficult and complex decisions a family can make. It may help to go through these steps in making your decision: Learn as much as you can about the medical situation and the likelihood of improvement. If your loved one prepared a health care directive , then use this to guide care decisions. If... read more...
    When is the right time to stop tube feeding?
    It can be very difficult to make decisions about feeding when people can’t eat on their own. Tube feeding is not considered a basic part of care. Health care providers, ethicists and the courts consider it to be artificial nutrition and a medical treatment. This makes it comparable to other medical treatments such as dialysis or assisted breathing. read more...
    Who decides when resuscitation is no longer an option?
    Resuscitation can mean different things. Here it’s taken to mean cardiopulmonary resuscitation (CPR). This is defined as the attempt to restore a heartbeat in someone whose heart has stopped beating and the attempt to restore breathing in someone who has stopped breathing. Decisions about resuscitation take into account many factors, a major... read more...
    Are my family members happy and content after death?
    Our concern and love for our family members does not end with their deaths. Unless we had unresolved issues with them, we want them to be happy and content. We may feel especially concerned about family members who had difficult lives or a hard time in dying. We hope that in death they will have the peace and happiness they could not find... read more...
    How can I help my mother prepare for death?
    It’s normal for people to feel a range of emotions when they’re told their illness is progressing and death isn’t far. Commonly people say they feel numb, sad, helpless, disappointed, angry, or afraid. Family members often report similar reactions. There really are no specific words to alleviate the stress of the situation, but there’s a lot... read more...
    How can I support my husband who’s been diagnosed with cancer and is waiting for test results?
    Waiting can add stress to an already uncertain situation. Some people say that waiting for health and treatment information is one of the most stressful aspects of being ill. There’s the frustration of waiting, and for some people there’s also fear of what the test results may be. The waiting period can be equally difficult for family and... read more...
    How do I cope with news that my dad has advanced cancer?
    It’s normal to feel lost and confused when you first get news that someone close to you has a terminal illness. You may feel all kinds of emotions and not be able to control them. The first task is to digest the news and make sense of it. It’s difficult and it takes time. Stop and reflect, think about your questions, and look for information... read more...
    How do I let go of my anxiety about death and about the meaning of life?
    Most of us struggle with the fact that life ends in death. When a family member dies or when we think about our own death, the mystery of death touches us personally. We may feel anxious about the way death cuts us off from people we love and care about. We may be frustrated or disappointed by how little solid evidence there is about what... read more...
    How do we maintain hope when we can see that our father’s condition is deteriorating?
    As your father’s health deteriorates, it may get harder to maintain the hopes that he and your family had when he first became ill. You may find it impossible to feel positive when symptoms persist, when new symptoms appear, when treatments don’t bring the results you wish for, or when physical well-being declines. Indeed, at times you may... read more...
    I am very close to my husband who has been given less than a year to live. How can I cope with losing him?
    This response is based on what we have learned from people who have gone down the road you are on now. Some things will fit for you and some things won't. The most important thing, in our view, is to know that there is no one right way to cope. The news that someone has less than a year to live can be overwhelming for the person who is told... read more...
    I would like to speak at my father’s funeral, but I don’t know what I should say and whether I can do so without breaking down? How do I prepare for this?
    Speaking at a memorial service is an honour. It gives you the privilege of paying respect to the person who has died, and of helping those who have gathered for the event. Speaking at your father's funeral is a special way of honouring him and the relationship you had with him. Your public mourning could be a significant healing step for you... read more...
    My father did not view himself as religious and was not connected with a church. How can we approach planning a memorial service?
    A memorial service can be a very helpful way for families, their neighbours and friends to mourn. It gives people an opportunity to express their grief; remember and honour the person who has died; experience a supportive community in the face of loss; consider the meaning of life and death within the web of life. Planning a memorial service... read more...
    My friend is living with a life-limiting illness and is very depressed. He cannot do the things he likes to do any more and he says he doesn’t want to live any longer. I am worried he will harm himself. How can I help him?
    A life-limiting illness is one of life’s most stressful experiences imaginable. The person who is ill may feel nobody can really understand what he is going through even when friends or family are trying to support him. Family and friends may feel frustrated that their efforts to care are not more appreciated. Ultimately you cannot control... read more...
    My grandfather who lives far away has been diagnosed with cancer that’s progressing quickly. I feel angry. How do I deal with that?
    It’s hard to face the thought of losing someone you love. Being far away makes it even harder. First, it’s important to talk to people. Talk to your family. Talk to your friends. People who’ve gone through what you’re going through and can give you the benefit of their experience. Even though you’re far away from your grandfather, you don’t... read more...
    My mother wants to die rather than remain bedridden in a long-term care facility. How can I help her spiritually?
    Your mother may be struggling with defining who she has become within her increasing physical restrictions. It is very difficult to be an observer of the suffering that comes with such a struggle. An important first step is to ask your mother and her health care team if she has any symptoms that affect her comfort. Uncontrolled symptoms such... read more...
    My mother’s dying and my father won’t talk about it. How can I help my father cope with my mother’s illness?
    Your father probably finds this a very difficult and stressful situation. People deal with stress in different ways, and no one approach is better than any other. As well, people’s responses can change over time. They may not want to talk right away, but may open up with time. Your father may not be ready to open up now. Fathers often feel... read more...
    My wife has been given less than a year to live. How can I help her to prepare for death? How do I respond when she cries?
    It is common for a person to feel a range of emotions when they hear their illness is progressing and death is not far away. The person may feel numb, sad, helpless, disappointed or angry, to name just a few possible reactions. You and other family members may have similar feelings. All of these reactions are normal. There really are no specific... read more...
    One of my work colleagues has recently found out she has a terminal illness. She comes from a different culture than mine – how can I be sensitive to her needs and offer help?
    The philosophy of palliative care encourages care for the whole person. Such care tries to meet the person’s spiritual, emotional, cultural, and social needs, as well as physical symptoms. Your colleague’s needs have been shaped by her culture. If you do not know about that culture, you may feel you don't fully understand her needs, and may... read more...
    What is spirituality? Is it different from religion? What if I don’t go to church or belong to a faith community?
    Every person has spirituality. Whatever moves or expresses your spirit or inner energy is part of your spirituality. In some senses your spirituality is expressed in every aspect of your personal and public life. It is just part of who you are – woven into and expressed through every thought, feeling, and action. There are many definitions... read more...
    My husband often vents his frustration and anger towards me. I know he is very ill and things aren’t going well, but how can I respond?
    This is a difficult and yet very common experience of caregivers. When someone is not well, they often take out their frustrations and anger on the person who is closest to them. Perhaps they feel it is a safe place to “just be themselves.” In terms of how to respond, it’s important to recognize that anger is a natural and powerful emotion... read more...
    Does needing a laxative to have a bowel movement mean there’s a bowel obstruction?
    A need for laxatives doesn’t mean there’s a bowel obstruction. People who are seriously ill often have trouble with bowel function. Laxatives are used to treat this before it has a chance to create a bowel obstruction. Two main reasons why a person who’s ill may need a laxative are: Some cancers affect how the bowel works. Any tumor located... read more...
    How long can someone live with a blocked large intestine?
    Several things affect how long someone can live with a blocked large intestine (also called a bowel obstruction ). Surgery may be considered if it has the potential to solve the problem by removing or reducing the obstruction. Surgery is an option if the blockage is caused by a tumor pressing on the bowel, or if there’s scar tissue or twisting... read more...
    My brother has cancer that has spread to his brain. Sometimes I can’t understand what he’s trying to say and he’s always fumbling with his blankets. Does he know who I am? Can he understand what we’re saying to him?
    From what you describe, your brother is showing signs of confusion. By understanding more about confusion, you can better understand what he is going through and what can be done. Confusion occurs when the brain is not working properly. Confused people often have problems remembering, paying attention, speaking, thinking, and understanding... read more...
    What causes drowsiness in patients with lung cancer?
    People who have lung cancer can be drowsy for several reasons. Most are problems that can be life-threatening if left untreated. Therefore, if a patient with lung cancer appears drowsy, it’s very important that she or he be seen by a health care provider as soon as possible. These are the most common problems that may cause drowsiness in someone... read more...
    My sister doesn’t have the energy to do anything any more. Why is this happening and what can we do for her?
    Each of us has reserves of energy that we use every day. Healthy people can replenish their energy stores. People with progressive illnesses use their energy stores to get through each day, but their illness prevents them from being able to top up their reserves. So they’re constantly spending their "energy savings. " A big challenge is that... read more...
    What causes hallucinations in patients with cancer?
    Some of the possible causes of hallucinations in cancer patients are: medications, especially strong painkillers, such as morphine or Dilaudid; chemical imbalances in the blood, such as high levels of calcium caused by a tumor; infections; tumor that has spread to the brain. It is important that a patient experiencing hallucinations be seen... read more...
    Does someone become less sleepy once the body adjusts to a changed dose of pain medication?
    Drowsiness or sleepiness is a common, temporary side effect of an increased dosage of morphine or other opioids. It usually takes two or three days to go away, but it can take longer. Occasionally it’s necessary to try other opioid medications to find the one that has fewest side effects for that person. The overall fatigue that people feel... read more...
    How do you use a pain scale?
    To ensure that a pain scale is serving its intended purpose, it helps to understand how it works. A pain scale is used to help assess severity of pain. Only the person experiencing pain can know exactly what it feels like, but describing it with words or numbers helps other people, particularly health care providers, at least understand something... read more...
    How does pain affect a person’s sleep?
    Pain often affects someone’s sleep quality, amount of sleep, and ability to fall asleep. If pain is treated then sleep usually improves. If the pain is treated and sleep is still a problem, there may be other options. A variety of medications may help. An anti-anxiety medication, which has sedative effects, can promote calm, so someone can... read more...
    My brother is dying of cancer and is suffering a tremendous amount of pain. Is it true that if pain medications are used now, there will be nothing to use later on?
    Almost all pain is controllable at all stages of an illness and at the end of life. It’s important to treat pain whenever it’s felt. There are many medications and options available. Dosages of some medications may be increased, or the medications may be changed. Several pain medications do not have an upper limit, so they can be increased... read more...
    My mother is dying of cancer and refuses to take morphine until the pain is almost unbearable. She gets annoyed when I try to talk with her about it. How can I raise this?
    It’s normal to be concerned about what’s happening and not to know what to say. It may help to come at this problem from a different angle. Sometimes it’s good to look at what’s behind a symptom. Your mother may find some meaning in putting up with pain without regular medication. She may want to try to overcome the pain on her own, and this... read more...
    What causes pain associated with bone metastasis?
    When a cancer has spread to a bone, it causes the structure of the bone to break down or to become abnormal. This also can cause swelling in the area. During these processes, the body sends a signal to the brain that there’s something wrong with that part of the body, which produces the sensation of pain. The pain of a bone metastasis is usually... read more...
    When I enter hospice, will I have any control over how much pain relief I can get? Will I be putting my doctor in a bad position by asking how much morphine would cause my death?
    Your current situation must seem overwhelming. So it’s natural to want to take control. In hospice, you can have a lot of control over your own health care. Before you enter hospice, it’s a good idea to meet with your health care team. They are the doctors and nurses who will provide your care. Review how you are feeling now and what might... read more...
    Can something be done to manage respiratory secretions when someone is dying?
    It’s common for secretions to build up in the lungs of people who are nearing death. The dying person usually doesn’t have enough strength left to cough and clear the fluids that continue to be produced by the lungs. Gradually these secretions collect. Generally it’s not helpful to suction secretions when someone is near the end of life. The... read more...
    Are there any medications to help someone who has difficulty breathing?
    Difficulty breathing is also called shortness of breath or dyspnea . It’s a common symptom in many diseases, especially in advanced stages. Many people describe it as feeling "hungry for air. " Opioid medications are commonly used to help control shortness of breath. In advanced stages of an illness, the treatment approach is similar to that... read more...
    Does abdominal swelling mean death is near?
    Swelling reflects the burden of illness on a person’s body. As the illness progresses, the burden increases further, and swelling may increase as well. If the swelling is the result of fluid collecting in the abdomen, it likely can be drained by paracentesis . As the rate of accumulation increases, paracentesis may be more frequent. At late... read more...
    What causes stomach swelling in someone with cancer? Can it be treated?
    In people with cancer, swelling of the stomach or abdominal area can have a few different causes. Fluid may collect in the area of the body containing the abdominal organs. This fluid is called ascites . It may result from the tumor causing the body to produce more fluid, or the tumor may be blocking the normal flow of fluid through the lymph... read more...
    Is it common for people who are dying to withdraw from family?
    As death nears, it’s very common for people to withdraw from social interaction. They may speak very little, even to loved ones, and may seem uninterested in what’s going on around them. Some family members describe this as the person just fading away. Social withdrawal is a natural part of the dying process and is not a judgment on others. read more...
    My mother has been diagnosed with a terminal illness and I need to make travel arrangements for visitors. How do I know how much time we have left?
    When someone in the family is diagnosed with a terminal illness, it’s important to do things sooner than later, rather than wait for the right time. The timing of a visit depends on how much visitors will want to talk and interact with your mother. Some people want to visit when the dying person has enough energy to talk and interact. Others... read more...
    What happens when someone is near death?
    There are several signs that can indicate that someone is nearing death: physical condition; eating; breathing; mental condition. Physical condition Deterioration in physical condition is usually the first sign that someone is near the end of life. The deterioration may be gradual or quick, and is reflected in the person’s level of energy... read more...
    Why do some people become suddenly alert for a while right before dying?
    Sometimes people who are in their final days or hours of life have a brief period of physical or mental improvement. It’s not clear why this happens, but these are some possible explanations: 1. A person near death may have spent a few days in an unresponsive state. This period without much activity may help the body rest, so the person may... read more...
    My father would like to die at home. What can we expect?
    Most people worry that their final days will be filled with pain and agitation. Usually the opposite is true. In the days and hours before people die, they typically spend most of their time asleep or resting. It’s rare for pain to get worse or for distressing symptoms to appear. Most often, the various body systems just gradually and quietly... read more...
    My mother wants to die at home. What do I do if there’s a serious emergency?
    Having your mother’s wishes outlined on paper will help both of you. If you know more about what your mother really wants, you’ll be assured that you’re following her wishes in an emergency, rather than making decisions for her. While the name and purpose varies across the country, most areas of Canada recognize health care directives, also... read more...
    Is it normal not to cry after someone close has died?
    Many people wonder if their grieving is normal. If you’re not crying you may feel you’re not grieving as you should, and it can make you uncomfortable. Yet, grief can be surprising and unpredictable; you may well feel emotions you hadn’t expected. It’s good to remember that your relationship with the person who died was unique, so the way... read more...
    My brother just died and the holiday season is coming. How can we cope?
    It’s normal to feel a mix of emotions during bereavement. Feelings of grief can come up at unexpected times, and holidays can be a trigger. The pressure of getting into the spirit of the season can add to the difficulties and churn up even more emotions. Some people who are grieving find it reassuring to participate in traditional holiday... read more...
    My husband died suddenly about a year ago. I’m still having trouble sleeping and I just wish the pain would end. Can you die from a broken heart?
    Learning to live without your husband, and adapting to a very different life without him is a demanding experience. This period is the most difficult, especially if your loss was sudden or unexpected, and if you didn’t have a proper chance to say goodbye. It’s part of the grieving process to feel immense sadness and miss the person who died. read more...
    Our family is helping to care for our mother who’s dying. My sister seems very angry that our mother is dying. Is this a normal part of the grieving process?
    Each person in your family has a unique relationship with your mother, so each of you will grieve her in a unique way. Also, each of you is unique in how you cope with stresses. These ways of coping apply to grief also. Sometimes grieving starts before someone dies. This is known as anticipatory grief . It seems that your sister is going through... read more...
    Our father died a few months ago, leaving only my sister and me in our immediate family. My sister was very close to Dad and spent lots of time with him. I am concerned about her. How do I know the difference between grief and depression?
    When people are coping with the death of someone significant in their lives, it can be difficult to know whether they are experiencing grief or depression. The Canadian Psychological Association describes the difference between the two: “Grief is often described as a longing for the person, a lack of acceptance of the death, memories that... read more...
    As an illness progresses and end of life is near, is it reasonable to discontinue medications?
    The health care team, the patient and the family together need to consider several factors before making any change in medications. All these questions need to be answered: What are the patient’s or family’s goals for care? This may be the most important question. The goals must be realistic and achievable. For example, it may not be realistic... read more...
    Does morphine make death come sooner?
    Many people worry about the use of morphine in palliative care . Morphine and other medications in the morphine family, such as hydromorphone, codeine and fentanyl, are called opioids. These medications may be used to control pain or shortness of breath throughout an illness or at the end of life.   Patients and families sometimes worry that... read more...
    Is there something other than Tylenol® that can be given for bone pain due to cancer?
    There are several options that can be considered for pain relief with bone pain. Tylenol® is the brand name of acetaminophen . It’s a good painkiller for bone pain, but it may not be strong enough to relieve completely the pain of cancer in the bones. The maximum dose of acetaminophen is 4, 000 mg a day. It’s very important to check with the... read more...
    My mother had regular pain medication at home, and it was working. When she was admitted to hospital, the pain medication was given “as needed.” Why was this changed?
    If your mother was receiving regular pain medication at home, the same dosage needs to continue in hospital. It’s rare that a pain medication regimen is stopped altogether and given just "as needed" (what health care providers call “prn”). One of two different things may be happening. Your mother may in fact be getting medications just as... read more...
    What are the side effects of dexamethasone?
    Dexamethasone (Decadron®) is one of a group of medications called corticosteroids. This group of medications has a set of side effects that together are known as Cushing’s syndrome. The common side effects include weight gain, increased appetite, bloating, filling of the face (called moon face) and filling of the abdominal area. These side... read more...
    What are the side effects of morphine? Does morphine change someone’s physical appearance?
    Morphine and other opioid medications generally have these side effects: Sleepiness Some level of sleepiness or drowsiness is common when the medication is first started or the dosage increased. It usually lasts about two to three days.   Fatigue     Nausea This may occur with the drowsiness. It too tends to subside after a few days, as the... read more...
    What can be done with medications that are left over after someone dies, or with medications that aren’t being used any more?
    It’s not a good idea to flush leftover medications down the toilet, as this pollutes the environment. It’s not a good idea either to keep medications at home, as this can be a safety issue. It is a good idea to take leftover medications to a pharmacy, so someone there can dispose of the medications properly. Most pharmacies take leftover medications... read more...
    What happens if someone has a morphine overdose? Is there a certain amount of morphine that can cause an overdose?
    The amount of morphine that can cause an overdose or death depends on what a person’s body is used to. It takes more morphine to cause an overdose in someone who is already taking morphine than in someone who has never had it before. Morphine and other opioids are given to control pain . When taking morphine for pain, the body may develop... read more...
    What is hydromorphone? Why might someone be switched from morphine to hydromorphone?
    Hydromorphone (Dilaudid®) is a painkiller in the opioid family, as is morphine. Hydromorphone is chemically related to morphine, and very commonly used for moderate to severe pain . Often people are switched from morphine to hydromorphone to treat possible side effects from ongoing use of morphine, such as confusion or uncontrolled jerking... read more...
    What’s the difference between hydromorphone, morphine, Dilaudid® and fentanyl patches? When would each of these be used?
    All these medications are opioids. This is a group of medications that target certain receptors in the body in order to relieve pain . When treating pain with opioids it’s typical to start with a low dosage, monitor to see how it’s working, and gradually increase the dosage until the person is comfortable. The monitoring is needed to check... read more...
    When I enter hospice, will I have any control over how much pain relief I can get? Will I be putting my doctor in a bad position by asking how much morphine would cause my death?
    Your current situation must seem overwhelming. So it’s natural to want to take control. In hospice, you can have a lot of control over your own health care. Before you enter hospice, it’s a good idea to meet with your health care team. They are the doctors and nurses who will provide your care. Review how you are feeling now and what might... read more...
    How should pain (fentanyl) medication patches be safely disposed of at home?
    Fentanyl patches contain strong medication and are placed on the skin to help relieve pain. The patches should be applied and removed as ordered by the doctor and only on the person for whom they were prescribed. Pain patches should not be placed in the garbage! There is still medication left in used patches when they are taken off the skin. read more...
    I’m concerned about what I hear in the media about fentanyl. Is it safe to use fentanyl? How do I use my patch safely?
    Fentanyl is a medication that’s been in the media a great deal recently. It plays a large part in the current opioid overdose crisis. It’s important to remember that this crisis is mainly due to illegal opioids being used for non-medical reasons . Street drugs can contain a variety of medications with unknown strengths mixed together. This... read more...
    How long can someone live without food or water?
    Estimating how long someone may live is very difficult. It’s usually discussed in terms of ranges; that is, hours to days, days to weeks, or weeks to months. It’s important to realize that every situation is different, that many factors are involved, and that everyone responds differently. Fluid intake has the biggest effect on immediate survival. read more...
    I feel guilty not being able to get my father to eat. What should I do?
    Families often have questions about eating and appetite when someone is ill. For families, the issue of food and eating involves much more than just the food. The whole experience of eating and fellowship is important. Also, feeding is seen as part of providing basic care for someone. Yet people who are terminally ill usually lose their appetite... read more...
    Is it painful when a person isn’t eating or drinking any more?
    While pain is a common symptom at the end of life, it isn’t caused by lack of food or fluids. People with a terminal illness don’t have a problem with "hunger pains. " Commonly they lose their appetite, their sense of hunger, and all interest in food. This can result from nausea, physical discomfort from eating even small amounts of food, and... read more...
    What can be done to improve someone’s appetite?
    Lack of appetite and the resulting weight loss can have many different causes. They can include illness, medications, treatments, pain , constipation or bowel obstruction , sores in the mouth, and anxiety or depression . It’s important to try to find the cause before trying a treatment. Poor appetite may be caused directly by a problem in... read more...
    What can be expected as brain cancer progresses?
    Someone with brain cancer can expect different kinds of symptoms, all of which change as brain cancer progresses. There’s likely to be an overall decline, which affects the body as whole. There also may be an effect on a specific area of the brain or on the whole brain, which may be caused by swelling and the tumor. Different areas of the... read more...
    What can be expected as leukemia progresses?
    Leukemia is different from many cancers, as there is no tumor. Rather, the cancerous cells are found throughout the body, in the blood or in bone marrow. Leukemia interferes with the normal production of red cells, white cells, and platelets in the bone marrow. The medications used to treat this disease may also injure the healthy stem cells... read more...
    What can be expected as lung cancer progresses?
    Someone with lung cancer may have symptoms specifically related to a tumor in the lungs and may have symptoms caused by the general effects of cancer on the body. When people have a tumor in the lungs, they often cough or are short of breath. Some people experience these throughout the illness. For others these may only become a problem as... read more...
    What can be expected with colon cancer that has spread to the lungs and liver?
    Each person’s disease progresses in its own way, and it’s not always possible to predict what can happen as a disease progresses. Someone with colon cancer may have symptoms specifically related to the tumor in the colon and may have symptoms caused by the general effects of cancer on the body. When cancer spreads to the lungs and liver the... read more...
    What can be expected with liver cancer?
    One of the most obvious effects of liver cancer is jaundice. This is a yellow discoloration of the skin and eyes, caused by a buildup of bile in the body. Bile contains a pigment called bilirubin that causes the yellow colour. Jaundice is a sign that the liver is not functioning well, and can’t move the bile to the intestine, where it’s normally... read more...
    What can be expected with liver metastasis?
    When cancer spreads to the liver the metastasis may have direct or indirect effects. This depends on the size and location of the metastatic tumor, and ranges from no visible effects to several serious ones. The person may also experience other symptoms caused by the general effect of cancer on the body. The liver is a large organ with a fair... read more...
    What can be expected with Non-Hodgkin’s lymphoma?
    Non-Hodgkin's lymphoma (NHL) is not a single disease. It’s a complex group of cancers that start in the body’s immune system. The diseases have similarities at the cell level, but they have different effects on the body and show different responses to treatment. A person’s experience with NHL will depend on the type of disease, its location... read more...
    What can be expected with radiation therapy for throat cancer?
    Much of what can be expected during cancer treatment depends on the specific individual. Many treatments place some burden on a person’s body. This is usually temporary, but requires a period of recovery. People who generally are doing fairly well are more resilient and recover more quickly. Those who generally are feeling exhausted and without... read more...
    What happens when someone has cancer?
    Each person’s illness and situation is unique, and so the person’s health care team is in the best position to provide specific information about what each person can expect. Some of the symptoms result from the type of cancer and where it’s located. Medications may also cause some side effects. As well, there are some general effects of cancer,... read more...
    Where can I find good information about cancer and cancer treatment?
    Learning about what might be expected as part of living with a disease often helps people feel more prepared or in control. There are many great websites that provide information about the various kinds of cancers, and how those cancers are diagnosed and treated. As you try to make sense of the information you find, it is important to remember... read more...
    What can be expected with congestive heart failure?
    Congestive heart failure (CHF) means the heart is failing to pump blood properly and can’t meet the requirements of the body. Different heart diseases or disorders can cause this condition. The degree of heart failure is often described using a system developed by the New York Heart Association. It has four classes, which define the degree... read more...
    My dad is living with several chronic illnesses and was recently hospitalized to manage his symptoms. It feels like a roller coaster – his health seems to change from one day to the next. What can we expect?
    It can be very difficult to predict the course of chronic illnesses such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Chronic illnesses place energy demands on the body that slowly deplete a person's energy reserve. In the later stages of illness, energy reserve is low, and seemingly small problems like... read more...
    How is diabetes best managed at the end of life, when the goal is comfort?
    When diabetes treatment is focused on making someone comfortable, the main goal is usually to avoid low blood sugar levels. Low levels cause the most symptoms in the short term and are most risky for the patient. There isn’t much margin for safety if they go even lower. So it’s preferable to have high levels rather than low. It’s reasonable... read more...
    My dad is living with several chronic illnesses and was recently hospitalized to manage his symptoms. It feels like a roller coaster – his health seems to change from one day to the next. What can we expect?
    It can be very difficult to predict the course of chronic illnesses such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Chronic illnesses place energy demands on the body that slowly deplete a person's energy reserve. In the later stages of illness, energy reserve is low, and seemingly small problems like... read more...
    What can be expected with kidney failure?
    One of the jobs of the kidneys is to remove waste products produced by normal body function. These waste products can be toxic. In the case of kidney failure, the kidneys can’t remove waste products effectively. As the toxins build up a person’s energy gradually decreases and the desire to rest increases. In the final days or weeks of life... read more...
    What can be expected in end-stage liver disease?
    The liver is the second largest organ in the body. It is located in the right upper abdomen under the rib cage. The liver has many important jobs. It filters harmful substances from the blood and converts food and fluid into the nutrients and energy the body needs. It also helps clot the blood. Causes of liver disease include viral hepatitis,... read more...
    My mother has end-stage Alzheimer disease. I think she may be in pain, but she isn’t able to communicate very well. How do I know if she is having pain?
    Assessing pain in a person with Alzheimer disease can be difficult. Pain assessment is usually based on the individual’s ability to verbally report his or her pain, but many people with Alzheimer disease have difficulty communicating. Some people are able to answer “yes” or “no” when asked if they have pain, and some can point to where it... read more...
    How do we care for someone with ALS?
    Amyotrophic lateral sclerosis, commonly called ALS or Lou Gehrig’s disease, is a progressive disease that affects the nervous system. The disease eventually affects someone’s mobility, independent functioning, communication, swallowing and breathing. Generally, care for people with ALS includes these considerations: the illness itself; the... read more...
    What can be expected as cerebral palsy progresses?
    The progression of cerebral palsy varies a great deal. In general, however, people with cerebral palsy have some common experiences in the final weeks or months: Decreasing strength and energy This causes decreasing mobility, communication, alertness and ability to breath and cough. Usually it’s not a cause of physical distress. Rather it’s... read more...
    What can be expected with end-stage multiple sclerosis?
    Multiple sclerosis (MS) is a progressive disease of the nervous system. It can cause a wide variety of symptoms, which may continue or worsen as the disease progresses. The most common symptoms include fatigue , walking difficulties, bowel and bladder disturbances, vision problems, changes in brain function, changes in sexual function, pain... read more...
    My dad is living with several chronic illnesses and was recently hospitalized to manage his symptoms. It feels like a roller coaster – his health seems to change from one day to the next. What can we expect?
    It can be very difficult to predict the course of chronic illnesses such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Chronic illnesses place energy demands on the body that slowly deplete a person's energy reserve. In the later stages of illness, energy reserve is low, and seemingly small problems like... read more...
    What can be expected with end-stage Alzheimer disease?
    Alzheimer disease is a progressive disease of the brain. It’s characterized by loss of memory, judgment and reasoning, changes in mood and behaviour, and eventually a reduced ability to perform the activities of daily living, such as eating, dressing, bathing and toileting. In end-stage Alzheimer disease, the brain is no longer able to tell... read more...
    How can home oxygen be adjusted to keep someone with advanced COPD comfortable?
    There’s often a difficult shift in perspective required at some point in a progressive disease. When someone has COPD, then throughout the illness there’s usually a focus on pulmonary function tests, treatments for infection, and efforts to slow the progression of the disease. As COPD reaches advanced stages, these efforts have less effect... read more...
    What can be expected with advanced COPD?
    The Canadian Thoracic Society defines COPD as "a respiratory disorder largely caused by smoking, which is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations". 1 Each person’s situation is very different, which makes it... read more...
    My dad is living with several chronic illnesses and was recently hospitalized to manage his symptoms. It feels like a roller coaster – his health seems to change from one day to the next. What can we expect?
    It can be very difficult to predict the course of chronic illnesses such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF). Chronic illnesses place energy demands on the body that slowly deplete a person's energy reserve. In the later stages of illness, energy reserve is low, and seemingly small problems like... read more...


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