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Ly activities (for instance day care, function and hobbies), care employees took over a growing number of daily tasks.Meanwhile, care staff increasingly put the emphasis on paying a lot more loving interest for the individual with ID and delivering comfort care, for instance holding hands, providing massages, supplying favorite foods, listening to favorite music, possessing reassuring talks, or undertaking smaller favored activities like blowing bubbles or watching football.Inside the final stage in life, even common care, including showering or consuming, was in some cases burdensome and new solutions necessary to become discovered, including decreasing time taken showering, washing inside a bath chair and offering favorite foods in a liquid kind.Josh's nurse described how she skilled the transition towards endoflife care: Josh's Nurse: `There are no `musts' anymore.It's a lot more about letting go, letting Josh have a fine last week.Let him snuggle in bed.He does not need to sit up if he does not possess the energy to complete so.Nevertheless it was quite hard to let it all go.I typically wondered: when am I going to take it all more than from him We've learned to encourage clients in all their each day activities as well as encourage them to perform more activities.Now you must let go.You should ask your self: who do I keep offering the activities for We're not performing him a favor.Josh will in no way be exactly the same particular person.This awareness came gradually, but it was really really hard.' As Josh's case illustrates, for most care employees, the shift from care as usual to endoflife care implied a continuous search for a new balance among supplying activities (perhaps adapted) and taking over tasks from the person with ID.This may very well be quite hard, since it implied `letting go' of parts of a care strategy that care employees identified with as becoming the essence of their perform, namely expanding the activities and encouraging selfreliance.All interviewees have been mentally competent folks and no interventions have been performed.In such circumstances, no approval by an ethics committee is needed EW-7197 custom synthesis within the Netherlands, according to the Healthcare Study Involving Human Subjects Act .All respondents received a letter informing them on the aim with the study and gave informed consent.Study participation was voluntary.The responses have been anonymous and nontraceable to folks.Results Relatives, care staff and ID physicians perceived a number of shifts in their care approaches and attitudes because the death of an individual with ID approached.5 shifts were distinguished.They're described beneath, like the values behind these shifts.To illustrate the shifts, we present the cases of Josh, Eleanor and Joe (see Table ; the names utilised inside the case descriptions will not be the subjects' genuine names).We also go over the extent to which they resemble the other cases studied.Bekkema et al.BMC Palliative Care  :Page ofFor most relatives, it was specifically difficult to see the decline inside the well being of their relative, especially when this was a process of fast deterioration.In some situations, the individual ended up within a wheelchair and sooner or later in bed in just a matter of days, not being able to consume or drink correctly.In other cases, the deterioration went more slowly, as an example inside the case of dementia or frailty because of old age.But even then, the person could turn out to be weaker promptly within the final weeks.Joe had cancer and his sister described how she experienced the shift: Joe's sister: `Joe usually liked to go outdoors.He had a custommade bike and we frequently went out together.He could also actually shake his head and say: "I do.