Medically assisted nutrition for palliative care in adult patients

Good, Phillip; Cavenagh, John; Mather, Mark; Ravenscroft, Peter J.

doi:10.1002/14651858.cd006274.pub2

Cited by 33 publications

(17 citation statements)

References 11 publications

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“…In our study, 24% percent of patients who received the dedicated encounter did not wish to rely on artificial nutrition. This preference is important to identify, especially among patients with advanced comorbidity and at high risk of cognitive decline, as there is no evidence to suggest that artificial nutrition prolongs survival, or improves quality of life in such patients (27, 28). The preference to avoid artificial nutrition is consistent with a previous cross sectional study where 39% of patients surveyed upon hospitalization for symptoms of advanced cancer expressed preference to forgo artificial nutrition (29).…”

Section: Discussionmentioning

confidence: 99%

Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project

Amro

Ramasamy

Strom

et al. 2016

American Journal of Kidney Diseases

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Background The Renal Physicians Association’s clinical practice guideline recommends that physicians address advance care planning with dialysis patients. Data are lacking, however, about how best to implement this recommendation. Study Design Quality improvement project in two Tufts-affiliated dialysis facilities in Boston, Massachusetts. Settings and Participants Nephrologists caring for patients treated with maintenance hemodialysis at two facilities identified patients who might benefit most from advance care planning using the “surprise” question (“Would I be surprised if this patient died in the next year?”). Quality Improvement Plan Patients identified with a ‘no’ response to the surprise question were invited to participate in nephrologist-facilitated advance care planning including the use of a medical Orders for Life-Sustaining Treatment (MOLST) form. Outcomes Change in MOLST completion rate and identification of preferences for limits on life-sustaining treatment. Measurements Pre- and post-intervention cardiopulmonary resuscitation status, MOLST completion rate, and vital status at one year were measured. Results Nephrologists answered ‘no’ to the surprise question for 50 of 201 hemodialysis patients (25%). Of these, 41 (82%) patients had a ‘full-code’ status and 9 (18%) had a ‘do not resuscitate’ (DNR) status. Encounters lasted 15–60 minutes. Following the encounter, 21 (42%) patients expressed preference for a ‘DNR’ status and 29 (58%) maintained full-code status (p = 0.001). The MOLST completion rate increased from 10% to 90%. One-year survival for patients whose nephrologists answered ‘no’ to the surprise question was 58% compared with 92% for those with a ‘yes’ answer (p < 0.001). Limitations Sample size and possible non-representative dialysis population. Conclusions Nephrologist-facilitated advance care planning targeting hemodialysis patients with limited life expectancy led to significant changes in documented patient preferences for cardiopulmonary resuscitation and limits on life-sustaining treatment. These changes demonstrate the benefit of advance care planning with dialysis patients and likely reflect better understanding of end-of-life treatment options.

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Section: Discussionmentioning

confidence: 99%

Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project

Amro

Ramasamy

Strom

et al. 2016

American Journal of Kidney Diseases

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“…This is partly because clinically relevant methods to distinguish impaired nutritional status caused by cachexia from that caused by simple starvation and secondary symptoms are not well developed [3,7]. A Cochrane review from 2009 [14] concluded that there are insufficient good quality studies to make any recommendations for practice with regards to the use of ETF or PN in palliative care patients. Raijmakers et al ’s more recent review [15] on cancer patients in the last week of life supports this conclusion.…”

Section: Introductionmentioning

confidence: 99%

A National Observational Study of the Prevalence and Use of Enteral Tube Feeding, Parenteral Nutrition and Intravenous Glucose in Cancer Patients Enrolled in Specialized Palliative Care

et al. 2013

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The use of artificial nutrition remains controversial for cancer patients in palliative care, and its prevalence is largely unknown. We therefore conducted a national study to investigate the prevalence, indications for, and perceived benefit of enteral/parenteral nutrition and intravenous glucose in this patient group. A cross-sectional study was performed within the palliative care research network in Sweden (PANIS), using a web-based survey with 24 questions on demographics, prescribed nutritional treatment, estimated survival and benefit from treatment. Data was received from 32 palliative care units throughout the country, representing 1083 patients with gastrointestinal and gynecological malignancies being the most common diagnoses. Thirteen percent of the patients received enteral/parenteral nutrition or intravenous glucose. Parenteral nutrition (PN) was significantly more common in home care units serving the urban Stockholm region (11%) than in other parts of the country (4%). Weight and appetite loss were the predominant indications for PN, with this treatment deemed beneficial for 75% of the palliative patients. Data show that there was great variation in PN use within the country. PN was predominately initiated when patients had weight and appetite loss but still had oral intake, indicating a use of PN that extends beyond the traditional use for patients with obstruction/semi obstruction.

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“…There is insufficient evidence that EN can improve patient outcomes and has been associated with increased burden and discomfort. 52,54 Although there may be times where EN may provide some value for personal, cultural or religious reasons, in general, at EoL, EN does not align with CKD-RSC goals of maintaining dignity and comfort, relieving symptom burden and improving QoL. 50…”

Section: Is Enteral Nutrition Appropriate At Eol?mentioning

confidence: 99%

Nutrition in Renal Supportive Care: Patient‐driven and flexible

et al. 2017

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Renal Supportive Care is an alternative treatment pathway in advanced chronic kidney disease that is being increasingly adopted, particularly in the elderly. Renal Supportive Care uses principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non‐dialysis pathway. Nutrition management is often an under‐recognized component of care and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of Renal Supportive Care are met. Nutrition interventions need to target patient and treatment goals, with frequent monitoring to ensure patient needs are being met. This review outlines available literature on this topic and suggests some practical ways in which nutrition can be enhanced for these patients.

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Medically assisted nutrition for palliative care in adult patients

Cited by 33 publications

References 11 publications

Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project

Nephrologist-Facilitated Advance Care Planning for Hemodialysis Patients: A Quality Improvement Project

A National Observational Study of the Prevalence and Use of Enteral Tube Feeding, Parenteral Nutrition and Intravenous Glucose in Cancer Patients Enrolled in Specialized Palliative Care

Nutrition in Renal Supportive Care: Patient‐driven and flexible

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