Background:The use of artificial nutrition, defined as a medical treatment that allows a non-oral mechanical feeding, for cancer patients with limited life expectancy is deemed nonbeneficial. High-quality evidence about the use of artificial nutrition near the end of life is lacking. This study aimed (a) to quantify the use of artificial nutrition near the end-of-life, and (b) to identify the factors associated with the use of artificial nutrition. Methods: This was a retrospective cohort study of decedents based on data from the French national hospital database. The study population included adult cancer patients who died in hospitals in France between 2013 and 2016 and defined to be in a palliative condition. Use of artificial nutrition during the last 7 days before death was the primary endpoint. Results: A total of 398 822 patients were included. The median duration of the last hospital stay was 10 (interquartile range, 4-21) days. The artificial nutrition was used for 11 723 (2.9%) during the last 7 days before death. Being a man, younger, having digestive cancers, metastasis, comorbidities, malnutrition, absence of dementia, and palliative care use were the main factors associated to the use of artificial nutrition. Conclusion: This study indicates that the use of artificial nutrition near the end of life is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer localization, presence of comorbidities or specific symptoms, may help to better manage its use. K E Y W O R D S artificial nutrition, cancer, end-of-life, health services research, registry database 5 | CONCLUSION This study indicates that the use of artificial nutrition near the end of life is rather low, which is in keeping with current clinical guidelines. The identification of factors associated with the use of artificial nutrition, such as cancer | 539 BAUMSTARCK eT Al.localization, presence of comorbidities or specific symptoms, may help to better manage its use, and may improve communication with patients, families, professionals, and health policy makers.
On February 2, 2016, the French government enacted the Claeys-Leonetti law introducing the right to deep and continuous sedation and forbade euthanasia for end-of-life patients. This article reports the first descriptions of this kind of intervention at the final stage of life of 3 patients and highlights the need of patient-centered goals and the importance of close collaboration between the patient, family, and medical and paramedical team to achieve a higher quality of final palliative care.
BackgroundOpinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care.MethodsWe performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built.ResultsSeventy-eight patients were interviewed. Median age was 60.5 years (range: 31–87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn’t believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age < 60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076–0.746]; p = 0.014, OR = 0.143 [0.044–0.469]; p = 0.001, and OR = 10.418 [2.093–51.853]; p = 0.004, respectively).ConclusionWe report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0357-6) contains supplementary material, which is available to authorized users.
El ensayo propone una discusión para comprender la educación como un acto político, desde las nociones sobre la desigualdad social que están implícitas en la primera fase de la obra de Freire. Para ello, se parte de la compresión de lo educativo, lo social y el conflicto en la relación sujeto oprimido-sujeto opresor. Asimismo, se aborda la centralidad que en ello adquieren nociones como lo dialógico versus lo antidialógico, el vínculo entre objetividad y subjetividad, los procesos de concientización y la praxis, es decir, la relación conjunta de la acción y reflexión crítica; todo ello en el marco de la educación liberadora. Una de las premisas del ensayo es que en la obra de Freire no hay mención explícita respecto a lo que actualmente se conoce como el enfoque de la “desigualdad social”, sino que esta se encuentra supuesta en la vasta discusión freireana. Se argumenta que, mediante relaciones antidialógicas, la definición de arbitrarios culturales y la educación bancaria, los sujetos opresores garantizan el mantenimiento de las condiciones materiales y simbólicas de opresión. Es decir, se trata ante todo de desigualdades de saberes, producto de una educación que no permite el proceso de la humanización y la concientización para la liberación de los oprimidos.
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