Death rattle : an exploration

Wee, Bee Leng (2003) Death rattle : an exploration. University of Southampton, Doctoral Thesis.

Record type: Thesis (Doctoral)

Abstract

The aim of this thesis is two-fold. First, to develop a method for capturing, analyzing and describing the sound of death rattle so that a benchmark can be set against which future investigations can be carried out. Second, to study the effect that the sound of death rattle has on those who hear it, especially patients’ relatives, so that, based on a better understanding of its impact, staff can give more appropriate and sensitive advice to those at the bedside.

A simple, portable and non-invasive recording system, acceptable to dying patients and their relatives, was developed using a minidisc recorder. The sound signals were successfully analysed using waveform and spectral analyses. Characteristic ‘rattle’ waveforms were identified in the sound recordings of death rattle and a convention established to describe its features. These waveforms were absent in recordings of normal breath sounds.

The impact of hearing the sound of death rattle was studied by using an interpretive research methodology. Individual face-to-face interviews were conducted with bereaved relatives using grounded theory principles. Focus group interviews were conducted with registered and auxiliary nurses, doctors, housekeeping staff, chaplains and hospice volunteers. The assumption that all relatives find the sound of death rattle distressing was not verified. Clear explanations appeared to be more important to bereaved relatives than pharmacological or physical intervention.

This thesis extends our knowledge and understanding of death rattle in the following ways. A simple, reliable and acceptable methodology for capturing and analyzing the sound of death rattle was developed. This may be used for objective evaluation of different treatments and further work on its pathophysiology. Relatives’ responses to hearing the sound of death rattle were found to be wide-ranging and complex. Health professionals need to adopt a more open and timely approach in discussing death rattle with relatives.

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