End-of-Life Nutrition Considerations: Attitudes, Beliefs, and Outcomes

2020 ◽  
pp. 104990912096012
Author(s):  
Tyler S. Loofs ◽  
Kevin Haubrick
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Health Outcomes ◽  
End Of Life ◽  
Meta Analysis ◽  
Artificial Nutrition ◽  
Decision Making Process ◽  
Artificial Nutrition And Hydration ◽  
Palliative Care Teams ◽  
Nutrition And Hydration

Objective: To assess the physiological outcomes and interpersonal influences that should be considered when making the decision to provide artificial nutrition and hydration (AN&H) for patients in hospice/palliative programs. Methods: A systematic review was conducted using items from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Distinct search strategies were employed to find primary research articles that addressed: General health outcomes of artificial nutrition and hydration interventions and nutrition therapy interventions (n = 16), nutrition-related symptoms in end-of-life care (n = 8), and the attitudes of patients and providers toward artificial nutrition and hydration (n = 21). Results: The effect of AN&H on health outcomes, quality-of-life measures and nutrition-related symptoms is limited and may vary by patient setting and diagnosis. In the absence of consistent evidence for specific health outcomes, decisions regarding AN&H should be made in context of the desires and beliefs of a patient, their family, and their medical providers. These beliefs may not be consistent with likely outcomes or may be inconsistent between individuals involved in the decision-making process, and individuals of different cultures or geographic regions may approach AN&H decisions from different perspectives. To help navigate the intersection of nutrition-related health outcomes and patient/provider beliefs, palliative care teams may employ a variety of strategies for approaching the decision-making process, and may benefit from specific involvement of a Registered Dietitian to help contribute to or lead these discussions.

Artificial nutrition and hydration at the end of life: Ethics and evidence

2006 ◽  
Vol 4 (2) ◽  
pp. 135-143 ◽  
Author(s):  
LINDA GANZINI
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Medical Treatments ◽  
Legal Principles ◽  
Feeding Tubes ◽  
Endoscopic Gastrostomy ◽  
Decision Making Capacity ◽  
Nutrition And Hydration

The case of Terri Schiavo resulted in substantial media attention about the use of artificial nutrition and hydration (ANH) especially by percutaneous endoscopic gastrostomy (PEG). In this article, I review ethical and legal principles governing decisions to choose or forgo ANH at the end of life, including issues of autonomy and decision-making capacity, similarities and differences between ANH and other medical treatments, the role of proxies when patients lack decision-making capacity, and the equivalence of withholding and withdrawing treatment. Evidence for palliative or life-sustaining benefits for ANH are reviewed in three disease processes: amyotrophic lateral sclerosis (ALS), cancer, and dementias, including Alzheimer's disease. Although more recent studies suggest a possible palliative role for ANH in ALS and terminal cancer, feeding tubes do not appear to prolong survival or increase comfort in advanced dementia of the Alzheimer's type.

Artificial nutrition and hydration for children and young people towards end of life: consensus guidelines across four specialist paediatric palliative care centres

2019 ◽  
pp. bmjspcare-2019-001909 ◽  
Author(s):  
Anna-Karenia Anderson ◽  
Kimberley Burke ◽  
Lizzie Bendle ◽  
Michelle Koh ◽  
Renee McCulloch ◽  
...  
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
End Of Life ◽  
Clinical Decision Making ◽  
Artificial Nutrition ◽  
Consensus Guidelines ◽  
Artificial Nutrition And Hydration ◽  
Paediatric Palliative Care ◽  
Nutrition And Hydration

There is a paucity of evidence on the role, use, benefit and challenges of artificial nutrition and hydration (ANH) in children at end of life. Parents express the difficulty they face with making the decision to withdraw ANH. Decision-making on the role of ANH in an individual child requires careful multidisciplinary team deliberation and clear goals of care with children and families. Four paediatric palliative care specialist centres reviewed the current literature and developed consensus guidelines on ANH at end of life. These guidelines seek to provide a practical approach to clinical decision-making on the role of ANH in a child or young person entering the end-of-life phase.

Views of Registered Dietitians Compared to Speech-Language Pathologists on Artificial Nutrition and Hydration at the End of Life

2021 ◽  
pp. 104990912199431
Author(s):  
Molly K Bigford ◽  
Roschelle Heuberger ◽  
Erica Raymond ◽  
Viki Shayna ◽  
James Paauw
Keyword(s):  
End Of Life ◽  
Terminal Illness ◽  
Descriptive Analysis ◽  
Study Patient ◽  
Artificial Nutrition ◽  
Speech Language Pathologists ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Evidenced Based ◽  
Registered Dietitian Nutritionists

Objective: To analyze and compare the knowledge and opinions of registered dietitian nutritionists (RDNs) about artificial nutrition and hydration (ANH) in a terminal illness. Beliefs of speech-language pathologists (SLPs) were also considered and compared against RDN data. Methods: This is a descriptive analysis utilizing survey responses from RDNs and SLPs regarding ANH in a case study patient with advanced dementia. Results: There was a strong belief among RDNs that ANH at end of life (EOL) would improve nutritional status, although a correlation was found between those in favor of ANH and believing it was ethical to withhold ANH at EOL (R2 = 0.109, p = 0.002). Responses indicated that SLPs need more education regarding ANH techniques, while RDNs felt ANH would improve aspiration risk. Place of employment, religion and age of respondents were also found to impact beliefs. Conclusion: Clinicians, specifically RDNs, working with patients at EOL need more evidenced-based education on the risks and benefits of ANH. Decisions regarding care of patients at EOL should be void of clinicians’ personal bias which may affect ethical treatment in the clinical setting. Further controlled trials must be performed before claims can be made regarding ANH at EOL.

Artificial nutrition and hydration

2015 ◽  
pp. 237-246
Author(s):  
Michelle S. Gabriel ◽  
Jennifer A. Tschanz
Keyword(s):  
Decision Making ◽  
Quality Care ◽  
Artificial Nutrition ◽  
Terminal Phase ◽  
Informed Decision Making ◽  
Artificial Nutrition And Hydration ◽  
Cultural Considerations ◽  
Nutrition And Hydration ◽  
The Right ◽  
Care Evaluation

Decreased appetite or inability to tolerate or enjoy food and fluids is often a hallmark of the terminal phase of an illness. Discussions and decisions regarding initiating or withholding artificial nutrition and hydration at the end of life are guided by goals of care, evaluation of benefits and burden, ethical and cultural considerations, and the beliefs and wishes of the patient and family. Patients have the right to refuse hydration and nutrition, whether parenteral or oral. Nurses are responsible for promoting patient autonomy, providing education regarding benefits and burdens of interventions in order, promoting informed decision making, and delivering quality care with the rest of the are team.

Sign in / Sign up

Export Citation Format

Share Document