Feeding at the End of Life in Brazilian Amazon: Qualitative Analysis of Medical Indications

Abstract

Background: Death is preceded by several medical decisions that impact the dying process. One of the challenges faced by the multidisciplinary team regarding the care for patients at the end of life process is the indication or interruption of enteral feeding. The aim of this study was to describe the decision experience of the indication of artificial nutrition for seriously ill patients at the end of life by physicians working in a private oncology clinic in Manaus-Amazonas (AM), and their perceptions about end-of-life process. Material and Methods: A cross-sectional and observational study based on a qualitative approach. A clinical case involving a hypothetical patient with advanced dementia, not a candidate for disease-modifying therapy, evolving with signs of end of life was applied. The doctors answered in a discursive manner a question about which nutritional option would be the most adequate. Content analysis was used to analyze the data. Results: A total number of 15 specialists physicians acting in a private oncologic clinic in Manaus-AMwere included. Approximately 42.84% of respondents opted to indicate the placement of a nasoenteric feeding tube or a gastrostomy. A large portion of them believed that the patient had the opportunity to treat severe dementia. Conclusions: There is little scientific evidence of the benefits of using artificial feeding in elderly patients with advanced dementia. Further studies are needed in addition to continuing educating initiatives to inform prescribing professionals about the potential related risks of artificial diet at the end of life.