Near death awareness (NDA) is a term to describe a dying person’s experiences of the dying process and broadly refers to a variety of experiences such as end of life dreams or visions. Up to 50-60% of patients could experience some form of NDA prior to their death.

The language patients use to communicate NDA may be symbolic and if caretakers are not aware that NDA can occur, patients may be ignored, treated condescendingly, or inappropriately medicated for delirium. Family, friends, and health professionals may respond with annoyance, frustration or fear. This, in turn, may cause isolation, suffering, and impair the dying person’s ability to communicate meaningful experiences at the end of life.

NDA emerges as distinct from delirious states. In general, as opposed to hallucinations in delirious states, NDA occur in clear consciousness; they are reported with clarity, detail, and organization; and they often evoke feelings of comfort, rather than distress.
NDA also differ from deathbed hallucinations with respect to their impact on patients. A study found that NDA tends to be spiritually transformative, while hallucinations tend to be relatively insignificant. In addition, deaths including NDA are more frequently calm and peaceful than are deaths without such experiences. Thus, NDA has been distinctly observed to affect positively the quality of the dying process.

The recognition of NDA requires attentive listening. Health professionals and family, friends can help interpret NDA messages: its content often will vary based on cultural background.

Several common experiences relating to NDA have been described and include:
• Communicating with or experiencing the presence of someone who is not alive.
• Preparing for travel or a change.
• Describing a place, they can see in another realm (i.e. heaven).
• Knowing when death will occur.

Caring for patients experiencing NDA should center on eliciting communication about the experience and accepting their significance for patients and families. Specifically, providers should:
• Evaluate for causes of delirium and treat when appropriate.
• Explore the meaning behind an expression of NDA and its impact on a patient’s psychosocial, emotional or spiritual distress. Accept and validate what the patient is telling; do not challenge or argue.

See reference for more information.

Adapted from Marks A & Marchand L. Near death awareness. Palliative Care Network of Wisconsin. Fast facts and concepts #118. Internet. Accessed on Sep 4, 2019.