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End-of-life care pathways, such as the Liverpool Care Pathway for the Dying Patient (LCP), are designed to support care for families and patients during the dying phase. The LCP provides a framework for clinical care in the dying phase, but it does not meet the criteria of rigorous scientific evidence, nor does it provide any tools or instruments to help physicians identify the onset of the dying phase.
The goal of our systematic literature review was to provide an overview of the published evidence supporting the timely recognition of the entry into the dying phase in patients with cancer.

Key points:
- Diagnosing dying’ – that is, recognising that a patient has
entered the dying phase – can be challenging and complex.
- The aim of our systematic literature review was to provide an
overview of the published evidence supporting the timely
recognition of the entry of cancer patients into the dying phase.
- Out of 12 eligible studies, only three can be seen as ‘dying-specific’
studies. They did not identify the same phenomena as indicating
entry into the dying phase, although there is some overlap.
- Out of the three ‘dying-specific’ studies, only one addressed the last
days of life in cancer patients and integrated ‘significant factors for
predicting dying’ into a computer-assisted prediction model.
- The literature does not provide an adequate basis for a systematic
review and the current evidence for both the signs and symptoms
of approaching death and the tools to diagnose it is poor.
- More and better-designed studies are needed to address
the lack of data in this field.