Parenteral nutrition at the end of life

Abstract

Background: Weight loss and undernourishment are common secondary diagnoses for cancer patients in the palliative phase. This often means that patients are treated with parenteral nutrition. Research shows that there is no clear benefit from treatment with parenteral nutrition when cancer patients approach the end of life. Whether to continue or stop the treatment can therefore represent a challenge for healthcare personnel, patients and their relatives. Few qualitative studies have investigated how healthcare personnel experience their work with parenteral nutrition at the end of life.Objective: The study's objective was to describe the challenges that healthcare personnel in hospitals experience in connection with administering parenteral nutrition to cancer patients at the end of life.Method: Qualitative study involving individual interviews with six registered nurses and two oncologists who work with cancer patients at two hospitals in eastern Norway. We made use of systematic text condensation to analyse the data. Results:The analysis revealed one overarching theme: making decisions about whether to stop parenteral nutrition at the end of life requires extensive experiencebased knowledge and interaction between doctors and registered nurses. Two main categories emerged: 1 dialogue, reflection and providing information about life and death to patients and their relatives 2 assessment perspectives and knowing the patient. Conclusion:The participants described the importance of communicating information about end-of-life parenteral nutrition at an early stage of the disease. The study suggests a need for clear routines and guidelines for parenteral nutrition, although the participants describe experience-based knowledge and interdisciplinary collaboration as the most important factors in assessing the patient's condition.A Norwegian study showed that 66 per cent of cancer patients on a palliative care ward, suffered from undernourishment 1 . Food and drink are essential parts of life, and cancer patients who are nearing the end of life, will often have a waning interest in food and drink 2 .When patients are unable to absorb sufficient nutrition orally or enterally, parenteral nutrition can be appropriate 3 . Parenteral nutrition is a medical treatment that involves administering intravenous nutrition straight into the vein 4 .Indications to start parenteral nutrition include expected shortening of life due to undernourishment, expected improvement to the quality of life, or that this is in accordance with the wishes of patients and their relatives 3 5 . Definition of the end of lifeIn a clinical context, healthcare personnel often define the end of life in different ways. It is far from easy to pinpoint the start of this phase. The Norwegian Association for Palliative Care and the Norwegian Association for Palliative Medicine define the end of life in this way: When the remaining life expectancy is likely, on balance, to be severely limited, often a matter of weeks or days. 6