Lastförlopp

Lastförlopp is a term used in Swedish medicine to describe the terminal phase of an illness—the final period during which the disease progresses toward death. The term emphasizes the trajectory toward the end of life rather than the underlying disease itself. The duration and expression of lastförlopp vary greatly between individuals and between conditions, making precise prognosis difficult.

Clinical features commonly associated with lastförlopp include progressive functional decline, reduced oral intake and thirst, increasing fatigue, decreased level of consciousness or responsiveness, altered respiration patterns, and episodes of delirium or agitation. Patients may experience increasing symptom burden such as pain, breathlessness, restlessness, secretions, and edema. Signs are highly individual and may not follow a fixed timetable.

Care in the lastförlopp focuses on comfort and quality of life. A palliative approach aims to relieve suffering, control symptoms, support families, and align care with patient preferences and values. Regular reassessment, clear communication about prognosis, and advance care planning are central. Decisions about interventions such as artificial nutrition and hydration, antibiotic use, or hospital transfers are made with a preference for non-aggressive measures unless there is a specific indication or patient/family wishes.

Ethical and cultural considerations play a major role, as beliefs about end-of-life care influence goals of treatment, whether to pursue life-prolonging measures, and where care is provided (home, hospital, hospice). Because lastförlopp can be difficult to predict, clinicians often plan for flexibility and reassessment as the situation evolves.