Understanding the 5 stages of palliative care can feel overwhelming when you’re supporting a loved one with a serious illness. Palliative care provides specialised, person-centred support for people with chronic diseases or life-limiting illnesses where a cure isn’t possible. This care approach helps people living with cancer, heart failure, chronic respiratory conditions, and neurological disorders such as dementia and Parkinson’s disease. It focuses on symptom relief and a better quality of life.
Knowing the different phases of palliative care helps you prepare and make confident decisions. Your loved one can receive palliative care alongside other treatments at any stage of their illness. The care journey moves through five distinct stages: stable, unstable, deteriorating, terminal and bereavement. A professional team supports both patient and family throughout.
This guide explains what to expect at each stage and how you can help. You don’t have to face this time alone. Here, you’ll find practical advice to plan care, manage changing symptoms, and support family members through grief.
Stage 1: Stable — Building the Foundation of Care
The stable phase lays the groundwork for the journey ahead. Your loved one’s symptoms are controlled, and their condition is steady. This is the time to build a clear plan for both present and future needs.
What Happens During the Stable Phase
In this phase, your loved one’s health concerns are manageable. Their treatment plan helps control symptoms and keep issues at bay. Medical teams recognise this stage when there is better functionality, fewer physical problems, and less need for intensive family support compared to later stages.
This period is ideal for putting good care practices in place. Many people think palliative care only means end-of-life care, but the stable phase shows that it can support someone at multiple points throughout an illness. Planning comes first: the team identifies current symptoms and any likely challenges ahead.
Healthcare providers can plan better interventions when they correctly identify this phase. They may consider if the person could benefit from more proactive support, advance care planning and connections to helpful community services.
Creating a Personalised Care Plan
A personalised care plan is essential. It looks after physical symptoms and considers emotional, social and spiritual needs for the patient and family. This plan is a shared guide that clarifies what matters most to your loved one.
The care team starts with a thorough assessment of medical, psychological, social and spiritual needs. They work to understand goals and priorities to create a plan that matches your loved one’s wishes.
A well-developed plan usually includes:
- A visit summary noting symptoms, concerns and findings
- Clear goals of care for both short and long term
- Specific strategies to manage each symptom
- Anticipated barriers to care with ways to address them
- Useful resources and support contacts
- Clear instructions for follow-up and emergencies
Importantly, the plan should remain flexible to adapt to changing needs. Regular reviews ensure it stays relevant. A strong plan can reduce uncertainty and bring peace of mind.
Who Is Involved in Early Palliative Care
Palliative care is a team effort, with professionals working together to meet complex needs. Doctors, nurses and specialists make up the core team. Social workers provide emotional support and help families connect with community services. Allied health professionals like physiotherapists, occupational therapists and speech therapists may also be involved, depending on individual needs.
Psychologists and spiritual care providers can offer additional support, and trained volunteers may help too. Family members and friends are vital parts of the team. Often, a family GP or community nurse leads the care, but sometimes a hospital palliative care doctor will coordinate care if the situation is more complex.
This team approach ensures consistent care across different settings, whether at home, hospital or residential facility.
Common Questions to Ask at This Stage
Some helpful questions include:
- What is happening with the illness now?
- What are our treatment goals?
- Will pain and other symptoms be well managed?
- How long might my loved one live with this condition?
- How do we contact the care team in an emergency?
- Can care continue at home if that’s preferred?
- What support is available for family and carers?
- How will other healthcare providers stay informed about my loved one’s care?
Stage 2: Unstable — Responding to New Challenges
The unstable phase marks a turning point. Your loved one’s condition has changed in ways that need immediate response from the care team.
Recognising Changes in Symptoms
In this phase, symptoms worsen or unexpected medical problems develop. The person’s health may decline faster than before, and pain or discomfort may increase. It can be a distressing time for everyone involved.
You may notice that:
- Existing symptoms worsen
- New symptoms appear
- Health declines faster than anticipated
- Pain increases and doesn’t respond to current treatments
- Family circumstances change, affecting care arrangements
Quick action during this phase can help stabilise symptoms and maintain comfort.
Adjusting the Care Plan Quickly
Once the care team recognises that your loved one is in an unstable phase, they act quickly to review and adjust the plan. This may involve new pain management options, changes to symptom relief measures or extra support services.
Updated plans include:
- Fresh approaches to manage worsening symptoms
- Strategies to ease pain and discomfort
- Guidance for carers about what to do
- Details of any new supports
Clear communication between the care team and family helps everyone feel more confident and prepared.
Emotional and Psychological Support for Families
This phase can feel emotionally draining. It’s normal for patients and family carers to experience heightened anxiety, sadness or fear when health declines unexpectedly. Family members may feel unprepared or overwhelmed by new responsibilities.
Professional support is crucial. Counsellors, psychologists and social workers can provide emotional guidance. Support groups help families connect with others facing similar situations, which can reduce feelings of isolation.
Involving Spiritual Care if Needed
Facing sudden health changes can raise deep questions about meaning and purpose. Spiritual care helps people explore these thoughts and find comfort. Spiritual support may come from chaplains, faith leaders, social workers or support groups.
Activities like music, art or storytelling can also help people process emotions and find peace.
Stage 3: Deteriorating — Preparing for End-of-Life Care
The deteriorating phase signals steady health decline. This time requires careful planning and extra support.
Signs of Health Decline
Unlike the sudden changes of the unstable phase, deterioration usually happens gradually. You may notice:
- A drop in physical function
- Worsening symptoms despite treatment
- Severe appetite or weight loss
- More drowsiness or fatigue
- Frequent infections
- Less interaction with surroundings
Your loved one may spend more time in bed, sleep more, eat less, or find it hard to swallow.
Transitioning to End-of-Life Care
This stage often leads families to think about end-of-life care. It’s important to talk openly with the care team about what to expect and how best to keep your loved one comfortable.
Care goals often shift more towards comfort and quality of life. These conversations help everyone prepare emotionally and practically.
Stage 4: Terminal — Final Days and Comfort Measures
The terminal phase focuses on comfort and dignity during the final days of life.
What to Expect in the Final Days
Physical changes may become more obvious. Your loved one might:
- Sleep more or become unresponsive
- Have changes in breathing patterns
- Show changes in skin colour or temperature
- Become less interested in food or drink
Some changes, like noisy breathing, can be distressing to hear but don’t usually cause discomfort for the person.
Managing Pain and Physical Symptoms
Pain relief and comfort care remain a priority. Healthcare providers use medication and non-medication strategies to manage pain, anxiety or other symptoms. Medication delivery may change if swallowing becomes difficult.
Creating a Peaceful Environment
The environment matters. Gentle lighting, soft bedding, favourite photos or music can make the space more calming. Reducing noise and allowing for quiet connection helps everyone feel more at peace.
Spiritual and Emotional Care
Spiritual care becomes particularly important for some people as they reflect on their life. Providing time for prayer, meaningful conversations or simple presence can help your loved one find comfort and closure.
Stage 5: Bereavement — Supporting Loved Ones After Loss
The bereavement phase shifts focus to family and friends after a loved one’s death.
Grief Counselling and Support
Grief affects everyone differently. Some people find comfort in talking to a counsellor, joining a support group or connecting with others who understand. Practical help with funeral arrangements or paperwork may also be needed.
Spiritual and Cultural Considerations
Grief often stirs questions about beliefs and traditions. Respecting cultural or spiritual customs helps people feel understood and supported.
How Long Does Bereavement Support Last?
Some families need ongoing support for months or even years. Services can include check-ins, counselling or group meetings to help people feel less alone.
Ready to Support Your Family Through Palliative Care?
Palliative care can feel daunting, but you don’t have to face it alone. At AHS Nursing Agency, we understand how important it is for families to feel supported every step of the way.
Our team is here to guide you, offer practical advice and provide compassionate nursing care that aligns with your loved one’s wishes. If you’d like help understanding what’s ahead or planning for the future, get in touch with us today.
