Endstadiet

Endstadiet is a term used in Dutch and related languages to describe the terminal phase of a progressive illness, in which curative treatment is no longer feasible or desired and the focus shifts to comfort, quality of life, and symptom relief. It is not a fixed moment but a stage in a disease trajectory, and prognosis varies widely among individuals. Endstadiet is often associated with palliative care, advance care planning, and discussions about goals of care.

Indicators of being in endstadiet include worsening symptoms despite treatment, increasing dependence on others, weight loss and reduced appetite, fatigue, breathlessness, persistent pain, cognitive changes, swallowing difficulties, and incontinence. Decisions about resuscitation, hospitalization, and continuing aggressive interventions are frequently revisited as the situation evolves.

Care during the endstadiet emphasizes comfort and holistic support. A multidisciplinary approach is common, involving physicians, nurses, palliative care specialists, social workers, and volunteers. Care settings may include the patient’s home, hospital, hospice, or palliative care units. Primary goals are symptom control (for pain, dyspnea, nausea, agitation), psychosocial and spiritual support, and assistance for families and caregivers. Clear communication about prognosis, preferences, and goals of care is central, often with advance directives and shared decision-making.

Common contexts include end-stage cancer, advanced heart failure, chronic obstructive pulmonary disease, kidney failure, and neurodegenerative diseases. Trajectories can be gradual or rapid, underscoring the importance of individualized planning and culturally sensitive discussions about end-of-life choices.