Communication
Good communication with a patient and family unit is vital for success in care giving. A fatal illness is a family experience. Communication means giving and getting medical information. This will help in making proper decisions related to care.

Cultural Variation
Culture is a system of shared symbols and guides us during our interactions with others. Cultural practices provide safety and security, integrity, and belonging. Culture is constantly evolving in response to historical and other factors. Culture is more than race/ethnicity. Race is not specific and is only one aspect of one's cultural identity.

Grief
Grief can affect the patient and the family. Each survivor experiences grief in his/her own way. They use their coping skills, in accordance with their cultural norms, belief systems, faith systems and life experiences.

Pain
Pain is an unpleasant physical and emotional experience cause due to some physical damage. There is no measure of pain. Self-report is the only valid gauge of pain. At times, patients may be unable to report their pain. In those circumstances family members, friends, or caregivers are asked to gauge the pain. At the end of life, many patients cannot communicate their pain due to certain poor conditions. If the patient has any potential physical reason for discomfort, they are considered to have pain until proven otherwise.

Spirituality
Spirituality includes the search for ultimate meaning and purpose in life. Each person has his or her own beliefs and experiences. Expressions of spirituality include music, art, nature, and other religious, philosophical, or supernatural beliefs. There are also spiritual aspects to many relationships people have. At life's crossroads, birth, deaths, marriages, or serious illness, we are reminded of just how spiritual life is and how important it is to attend to our own sense of meaning.

What to expect at the time of death?
The dying process is a natural slowing down of physical and mental processes. No one can predict the exact time of death. Some patients seem to know when death will occur. Death prediction is affected by the disease, and patient's will to live. Signs and symptoms of the dying process only serve as a guidelines. Not all patients experience all symptoms, and the signs and symptoms do not necessarily occur in sequence. Signs and symptoms can occur days, even weeks before the death, or may be present only hours or minutes prior to death.

What to expect of quality of life at end of life
For patients with advanced stages of serious illnesses, it is just not possible to promise cure or restoration of health. What would matter to such a patient? There are seven promises made by the health care system that really seem to make a difference. In each case, there is a short name for the promise, its core statement, and a few examples of what the patients should do to ensure receiving the best care.