{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T08:02:10Z","timestamp":1784707330865,"version":"3.55.0"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T00:00:00Z","timestamp":1784419200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Hosp Palliat Care"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate prognostication during the actively dying phase remains a major challenge in palliative care, particularly in home hospice settings where bedside assessment plays a central role. Neurological deterioration preceding death may provide clinically useful indicators of impending death; however, its temporal progression has not been well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective observational study of terminal cancer patients receiving home hospice care between April 2022 and March 2025. A total of 236 patients who died at home were included. Neurological signs\u2014including newly developed neuropathic pain, urinary retention, loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, impaired consciousness, open mouth posture, hyperpyrexia, apnea episodes, and pupillary dilation\u2014were prospectively recorded. The timing of each neurological sign relative to death was documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Neurological signs appeared in a recognizable temporal sequence preceding death. Urinary retention appeared earliest, with a median onset of 4 days before death (interquartile range [IQR], 1-7 days), followed by newly developed neuropathic pain at 3 days (IQR, 1-5 days). Loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, and apnea episodes typically occurred approximately 2 days before death. Impaired consciousness, open mouth posture, hyperpyrexia, and pupillary dilation occurred closer to death, with median onset times of 1 day before death. Loss of facial expression was the most frequent neurological sign (96.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Neurological deterioration follows a recognizable temporal pattern in terminal cancer patients receiving home hospice care. Systematic assessment of these neurological signs may support bedside prognostication, facilitate anticipatory guidance, and help families prepare for the dying process at home.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10499091261466232","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T04:57:29Z","timestamp":1784523449000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Bedside Neurological Signs of Impending Death in Terminal Cancer Patients Receiving Home Hospice Care"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8628-5451","authenticated-orcid":false,"given":"Kunihiko","family":"Watanabe","sequence":"first","affiliation":[{"name":"Home Hospice, Takanezawa, Tochigi, Japan"},{"name":"Department of Anesthesiology, Dokkyo Medical University. Mibu, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumi","family":"Tochimura","sequence":"additional","affiliation":[{"name":"Visiting nurse Venus Takanezawa, Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Fujita","sequence":"additional","affiliation":[{"name":"Visiting nurse Venus Takanezawa, Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukie","family":"Kushima","sequence":"additional","affiliation":[{"name":"Hinata Visiting Nursing Station, Nasushiobara, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiko","family":"Kushima","sequence":"additional","affiliation":[{"name":"Hinata Visiting Nursing Station, Nasushiobara, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kamiyama","sequence":"additional","affiliation":[{"name":"Home Hospice, Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akemi","family":"Hemmi","sequence":"additional","affiliation":[{"name":"Visiting nurse Venus Takanezawa, Takanezawa, Tochigi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,19]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1177\/082585979601200102"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2014-0312"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29048"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2021.1573"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-024-01637-7"},{"issue":"1","key":"e_1_3_6_7_2","first-page":"81","article-title":"Perspectives in preparedness of family caregivers of patients with cancer providing end-of-life care in the home: a narrative review of qualitative studies","volume":"7","author":"Bee PE","year":"2009","unstructured":"Bee PE, Barnes P, Luker KA. Perspectives in preparedness of family caregivers of patients with cancer providing end-of-life care in the home: a narrative review of qualitative studies. Palliat Support Care. 2009;7(1):81-90.","journal-title":"Palliat Support Care"},{"issue":"4","key":"e_1_3_6_8_2","first-page":"1","article-title":"Factors determining prognostic survival period in terminally ill patients receiving home care","volume":"6","author":"Hemmi A","year":"2025","unstructured":"Hemmi A, Watanabe S, Watanabe K. Factors determining prognostic survival period in terminally ill patients receiving home care. J Jpn Assoc Home Care Med. 2025;6(4):1-7.","journal-title":"J Jpn Assoc Home Care Med"},{"key":"e_1_3_6_9_2","first-page":"249","article-title":"The role of home hospice in community medical care: considerations for continuing home treatment of advanced cancer patients until end of life","volume":"40","author":"Watanabe K","year":"2013","unstructured":"Watanabe K. The role of home hospice in community medical care: considerations for continuing home treatment of advanced cancer patients until end of life. Dokkyo J Med Sci. 2013;40:249-256.","journal-title":"Dokkyo J Med Sci"},{"issue":"1","key":"e_1_3_6_10_2","first-page":"50","article-title":"Prospective neurological analyses of patients with advanced cancer receiving home care","volume":"25","author":"Watanabe K","year":"2017","unstructured":"Watanabe K, Hemmi A, Tajitsu T, Narita J, MacLeod R. Prospective neurological analyses of patients with advanced cancer receiving home care. Hosp Care Home Care. 2017;25(1):50-53.","journal-title":"Hosp Care Home Care"},{"issue":"5","key":"e_1_3_6_11_2","first-page":"807","article-title":"Logical explanation of medical conditions for patients with terminal cancer at home: a retrospective analysis of 145 cases","volume":"47","author":"Watanabe K","year":"2020","unstructured":"Watanabe K. Logical explanation of medical conditions for patients with terminal cancer at home: a retrospective analysis of 145 cases. Gan To Kagaku Ryoho. 2020;47(5):807-810.","journal-title":"Gan To Kagaku Ryoho"}],"container-title":["American Journal of Hospice and Palliative Medicine\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261466232","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10499091261466232","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10499091261466232","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T07:20:53Z","timestamp":1784704853000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10499091261466232"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,19]]},"references-count":10,"alternative-id":["10.1177\/10499091261466232"],"URL":"https:\/\/doi.org\/10.1177\/10499091261466232","relation":{},"ISSN":["1049-9091","1938-2715"],"issn-type":[{"value":"1049-9091","type":"print"},{"value":"1938-2715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,19]]},"article-number":"10499091261466232"}}