Management of death rattle: What influences the decision making of palliative medicine doctors and clinical nurse specialists?

Death rattle or noisy, rattling breathing occurs commonly in dying patients and yet there has been only minimal research into this symptom. Little published research has been conducted into factors that influence the management of death rattle. The main aim of this study was to further our understanding of the factors that influence the decision-making process surrounding death rattle. This was a qualitative study using semi-structured, face-to-face interviews with 15 palliative medicine doctors and clinical nurse specialists working in two palliative care centres in the UK. Patient, family and staff factors were all found to influence decision making, with regard to their management of death rattle, along with local policy, ethical considerations and prior learning. The majority of participants felt that there was a negative impact on them when caring for a patient with death rattle, ranging from uncomfortable through to distressing or hard. This study has contributed to a template for further research that is required in order to develop 'best practice' or 'gold standard' management of death rattle, and how to document this, whilst also ensuring an ongoing exploration of the complexities of clinical practice.