Natural Body Posture of Preference in the Dying Process: An Explorative Observational Study in a hospicesetting

Background: All people have different postures while sleeping. Most people will prefer a lateral position. In the last days and hours before dying, patients are usually to be found in a supine position. In literature so far it has never been questioned whether the supine position is the most comfortable posture for every dying person and its possible consequences for the quality of dying.
Aim: To explore or hospice patients wish to be helped in their natural body posture of preference (NBPP) and whether NBPP contributes to an improvement of quality of dying.
Methods: In an explorative observational study, patients with immanent risk of dying were questioned about their favorite position during sleep. Besides they were asked whether they would like to be helped in this position in the last hours of life. After a confirmative answer, patients were assured to be nursed in their favorite posture during their final hours. To evaluate the maintenance of this promise, photographs were taken to capture the wanted position directly following the interview and directly after dying.
Findings: 14 out of 22 patients died in their NBPP; 1 person died acutely, 5 patients returned home and 2 patients were still alive at the end of inclusion. All relatives reported that seeing their beloved one dying in a familiar and comfortable posture provided support and comfort. The natural position diminished their relative’s impression of suffering dying. Nurses were positive toward helping patients in their NBPP.
Conclusions: This first explorative intervention study about NBPP provides a visualization of concrete wishes and supports the assumption that hospice patients have a need and opportunity for their unique need to be known until the moment of death. Relatives and professionals are positive about this careful personalized intervention to improve comfort in the last hours of the dying patient.