Nutrition, quality of life and palliative care: integrative review

Abstract

BACKGROUND AND OBJECTIVES: Adequate nutritional intervention promotes wellbeing, symptoms control and improved quality of life for patients and their families. This study aimed at evaluating whether nutrition may or may not improve quality of life of patients under palliative care. CONTENTS: This is an integrative review using Pubmed, Scielo and Medline databases. Guiding question was: "Is nutritional therapy able to improve quality of life of patients under palliative care?" Six articles met pre-established inclusion criteria. Nutritionists were professionals most orienting nutritional therapy, in addition to explaining nutritional strategies to minimize dietrelated discomforts. Adequate therapy should respect dietary and cultural preferences, thus assuring better quality of life. CONCLUSION: Nutritional approach during palliative care should respect patients and their families' decisions and bioethics principles. Nutritional interventions should give more importance to counseling and support, instead of focusing just on matching nutritional needs. Nutritionists should orient patients and their families about nutritional therapy, in addition to giving further explanations to prolong survival, decrease weight loss and improve quality of life. RESUMO JUSTIFICATIVA E OBJETIVOS:A intervenção nutricional adequada promove bem-estar, controle de sintomas e melhora da qualidade de vida dos pacientes e de seus familiares. O objetivo deste estudo foi verificar se a nutrição pode ou não melhorar a qualidade de vida do paciente em cuidados paliativos.© Sociedade Brasileira para o Estudo da Dor as bases de dados Pubmed, Scielo e Medline. A pergunta norteadora foi "A terapia nutricional é capaz de melhorar a qualidade de vida dos pacientes em cuidados paliativos?". Seis artigos se enquadravam nos critérios de inclusão pré-estabelecidos. O nutricionista foi o profissional que mais orientou sobre a terapia nutricional em uso, além de fornecer esclarecimentos sobre estratégias nutricionais para redução de desconfortos ligados à alimentação. A terapia adequada deve respeitar as preferências alimentares e culturais, garantindo, assim, melhor qualidade de vida. CONCLUSÃO: A conduta nutricional em cuidados paliativos deve respeitar as decisões do paciente e de sua família e os princípios bioéticos. As intervenções nutricionais devem dar maior importância à prestação de aconselhamento e de apoio, ao invés de centrar apenas na adequação das necessidades nutricionais. O nutricionista deve orientar o paciente e sua família sobre a terapia nutricional em uso, além de fornecer orientações e esclarecimentos, a fim de prolongar a sobrevida, reduzir a perda de peso e melhorar a qualidade de vida. Descritores: Bioética, Cuidados paliativos, Nutricionista, Qualidade de vida, Terapia nutricional.

Atendimento fonoaudiológico para pacientes em cuidados paliativos com disfagia orofaríngea

“…In clinical practice, the decision must be made as a team, respecting the choice of the patient and family; these are considerations that must also be evaluated in other chronic diseases, on a case-by-case basis. Other studies reported that the introduction of an alternative feeding route in palliative care should be rethought, since, at this stage, the objective of nutritional adequacy does not exist anymore and that, despite reducing the chances of laryngo-tracheal penetration and/or aspiration, the NET will not prevent aspiration pneumonia (23)(24)(25) . In the present study, a small portion of the patients in the sample performed exercises to improve the swallowing function.…”

Nutrition at the End of Life: Basic Care or Treatment?

“…Studies by authors such as Mitchell J, et al [6]; Rio MI, et al [7]; Cotogni P, et al [8]; Boulanger A, et al [9]; Doig GS, et al [10]; Morais SR, et al [11]; Dev R, et al [12] and Marcolini EG, et al [13] have shown that nutrition at the end of life can have psychological benefits, as well as a positive impact on the symptoms associated with the disease such as management of the effects of cancer treatments, weight loss and nausea, maintaining muscle mass, reducing oxidative stress, improving inflammatory processes, minimizing the catabolic state, fighting malnutrition and enhancing the immune system, among others.…”

Brazilian Nutritional Consensus in Hematopoietic Stem Cell Transplantation: Elderly

“…According to the World Health Organization (WHO), palliative care (PC) is the approach to promote quality of life for patients and family members who are facing problems associated with life-threatening diseases, preventing and relieving their suffering through early identification, assessment and treatment of pain and other physical, psychosocial and spiritual problems. ( 127 , 128 )…”

“…The use of artificial feeding, whether by enteral or parenteral nutrition, has been proven to have no clinical benefit - on the contrary, it may even cause suffering to the patient. ( 108 , 127 , 140 , 142 , 143 )…”