Nutritional Palliative Care Issues

Abstract

Food and nutrition have social, spiritual, and cultural overlaying meanings beyond their importance to the biological integrity of human beings. The balance of benefit and burden with natural and artificial nutrition and hydration is complex and dynamic. Total parenteral nutrition (TPN) may be helpful if the GI tract is not working and the illness and/or the complication is reversible and there is a reasonable likelihood of significant recovery. Oral, gastrointestinal (GI), or intravenous (IV) intake can be a net harm to the actively dying person who is not always capable of taking in or utilizing nutrients and water. Medical nutrition and hydration should cease before net harm occurs, but defining the moment of net harm remains a challenge to healthcare providers. The goals of nutrition should be considered in a patient with poor functional status and prognosis. Artificial nutrition and hydration should only be used as a bridge to attain a functional or quality of life goal as defined by the patient with a life-limited diagnosis. Artificial nutrition and hydration are optional at the end of life and the burdens and benefits must be considered. The perspectives of various stakeholders regarding the role of food and water, nutrition and hydration at the end of life are important to consider. Issues surrounding artificial nutrition elicit strong emotional responses, making effective communication with the patient/family unit about food and nutrition and fluid essential.