Nutrition in palliative and end-of-life care

Abstract

Recent publications regarding nutrition highlight the importance of eating and drinking for patients and their family/carer. This article focuses on the importance of nutrition and early nutritional intervention, giving guidance for nurses when caring for patients with palliative and end-of-life care needs when the focus of nutrition centres around symptom control and quality of life. Clear, sensitive communication, with agreed nutritional goals set with the patient and their family/carer, and regular review and adaptation throughout any 'cancer journey' are paramount in order to minimise anxiety and distress. A multidisciplinary team approach is often required in order to support ethical decision-making and to assist in devising an individualised nutritional management plan. Although this article aims to focus upon the nutritional aspects associated with advancing cancer, many aspects will clearly be transferrable to patients with other life-limiting illnesses such as dementia and advanced cardiac and pulmonary disease.

Soins de fin de vie pour les patients atteints d’un virus respiratoire extrêmement transmissible : implications pour la COVID-19

“…Intravenous fluids and nasogastric feeding do not contribute to patient comfort at end-of-life, and may lead to complications such as pulmonary or peripheral edema. 48,49 Discontinuing fluids and artificial hydration and nutrition is generally recommended. Families may worry that withdrawal of hydration and nutrition support may increase suffering at end-of-life.…”

“…Discussing the risks of continuing these interventions and that patients often do not feel hunger or thirst when their body is dying can help substitute decisionmakers make informed decisions. 48,49 If artificial hydration and/or nutrition are continued, careful monitoring for complications of volume overload is needed. If a Foley catheter is not already in place, the clinician can consider serial bladder scans to ensure that urinary retention is not a source of patient discomfort or insertion of an indwelling catheter.…”

Atuação do nutricionista para melhora da qualidade de vida de pacientes oncológicos em cuidados paliativos

“…No contexto dos cuidados paliativos oncológicos, a ação dos nutricionistas se apresenta como um importante fator para a qualidade do serviço oferecido e os bem-estar dos pacientes e suas familías. Pacientes oncológicos em CP enfrentam diversas alterações relacionadas à alimentação, como a perda ou diminuição da capacidade de deglutição e digestão, redução na palatabilidade dos alimentos, má absorção de nutrientes, desinteresse e recusa dos alimentos de maior preferência, estando estes sintomas associados aos fármacos utilizados para tratamento e à própria doença que leva ao comprometimento do estado nutricional e da QV 19 . Dentre os sintomas que podem afetar diretamente o estado nutricional, encontra-se a mucosite oral, observada como principal efeito agudo em pacientes que realizam radioterapia na cavidade bucal, sendo consequência de um processo inflamatório local.…”

Nutrition in Renal Supportive Care: Patient‐driven and flexible

“…There is insufficient evidence that EN can improve patient outcomes and has been associated with increased burden and discomfort . 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 …”

“…End-of-life care can be defined as the final months or weeks of life. 50 There is limited literature or evidence regarding nutrition management at EoL in the renal population, with current knowledge predominantly coming from oncology and palliative care. A reduced desire and ability to eat and drink are key features of the dying process.…”