The associations of palliative care experts regarding food refusal: A cross-sectional study with an open question evaluated by triangulation analysis

Fringer, André; Stängle, Sabrina; Büche, Daniel; Ott, Stefan; Schnepp, Wilfried

doi:10.1371/journal.pone.0231312

Cited by 4 publications

(3 citation statements)

References 44 publications

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“…Indeed, eating challenges were a common consideration in identifying significant change in status of LTC residents, several of which (eg, low food/fluid intake, refusal to eat, swallowing difficulty, weight loss) are commonly associated with mortality. 25,31,[54][55][56] However, with the exception of swallowing difficulty, none were associated with a specific point in the end-of-life trajectory from the perspective of care providers. Non-nutritional signs were also identified.…”

Section: Discussionmentioning

confidence: 99%

Nutrition and Non-Nutrition-Related Challenges Predict Time to Death in Long-Term Care Residents: A Retrospective Chart Review

Morrison-Koechl,

Liu,

Banerjee

et al. 2023

JMDH

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Purpose Signals of end-of-life decline observed in daily habits, such as mealtime participation, are important for moving towards comfort-focused goals of care in the final months of life of long-term care (LTC) residents. It is unclear how eating issues observed in real-time in LTC homes are used as indicators of suspected end of life. The study quantifies nutrition and key non-nutrition related signals (eg, general decline, unstable vitals) documented to describe end-of-life decline and the subsequent time to death. Patients and Methods A retrospective chart review identified the first documented conversation where end-of-life decline was considered by members of the care team (eg, nurses, physicians, dietitian, family member) for 76 randomly selected decedents from 9 LTC homes in southwestern Ontario, Canada. Time (days) to death was calculated. A directed content analysis of the free-text description of the suspected end-of-life decline was used to categorize signals. Cox proportional hazards regression analysis tested the risk of mortality associated with each categorized signal. Results Time to death of residents (mean age = 88 ± 7 years; 60% female) from the first documentation of potential end-of-life decline ranged from 0 days to over 2 years prior to death (median = 27.5 days). Seven nutrition-related and 18 non-nutrition related signals were identified. Swallowing difficulty (HR = 2.99; 95% CI = 1.41, 6.33), cognitive decline (HR = 0.40; 95% CI = 0.20, 0.77), delirium (HR = 13.23; 95% CI = 1.57, 111.69), and cancer (HR = 0.18; 95% CI = 0.07, 0.48) were associated with time to death. Conclusion This study provides insight into the signals used by care providers in LTC to suspect that residents are declining towards the end of life and identifies four signals that were associated with time to death. When identified by care providers as indicators of end-of-life decline, swallowing difficulty and delirium predicted a shorter time to death, while cancer and cognitive decline predicted a longer time to death. Recognition of nutrition and non-nutrition related signals may be leveraged to systematically introduce timely comfort care conversations.

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Section: Discussionmentioning

confidence: 99%

Nutrition and Non-Nutrition-Related Challenges Predict Time to Death in Long-Term Care Residents: A Retrospective Chart Review

Morrison-Koechl,

Liu,

Banerjee

et al. 2023

JMDH

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“… 35 In palliative care, individuals may face challenges such as poor appetite, difficulty eating, or weight loss due to the underlying illness or treatment side effects. 46 , 47 Providing appropriate nutritional support helps address these issues and ensures that patients receive the necessary nutrients to meet their nutritional requirements. By enhancing the nutritional status of patients, nutritional support can have several positive outcomes.…”

Section: Discussionmentioning

confidence: 99%

Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review

Haroen,

Harun,

Sari

et al. 2023

JMDH

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Background: Palliative care is an integral part of care for patients with life-limited diseases that focuses on reducing symptoms and maintaining and increasing the quality of life (QoL) for patients and their families. Geriatric patients were more likely to receive palliative care and had unique needs compared to the general population. To improve the quality of palliative care, especially for geriatric patients, it is necessary to have a better understanding of methods and outcomes for geriatric patients when delivering palliative care.Objective: This study aims to identify the methods and outcomes of palliative care in geriatric patients across the globe. Methods: This scoping review was guided by Arksey and 'O Malley's framework and utilized the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist for providing transparent reporting to the readers. EBSCO, PubMed, and Scopus databases were used to search the relevant articles with a publication range of 2013-2023. Thematic analysis was used to identify and summarize palliative care methods and outcomes for geriatric patients in this review. Results: Twenty-one studies were included in this review, and it was found that there were many types of methods for delivering palliative care to geriatric patients. In both acute care settings and community settings, a wide range of methods for delivering palliative care to geriatric patients were identified. Outcomes of palliative care in geriatric patients in hospitals and community settings, were reduced pain, depressive symptoms and anxiety, edema, constipation, odds of in-hospital death, and increased spiritual well-being, QoL and well-being, being comfortable, patient readiness, place of death, sleep quality, and quality of dying. Conclusion: Geriatric patients had a variety of methods and outcomes in palliative care. This study suggests that outcomes should be evaluated continuously after implementing methods for delivering palliative care to geriatric patients.

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“…The process to decide should be a common practice among physicians, especially when they care for patients with advanced diseases. However, many of them still face problems associated with indications or interruption of treatments during the trajectory of some illnesses [3].…”

Section: Introductionmentioning

confidence: 99%

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

Anjos¹,

Dambrowski²,

Godoy³

et al. 2023

Supportive and Palliative Care and Quality of Life in Oncology

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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.

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The associations of palliative care experts regarding food refusal: A cross-sectional study with an open question evaluated by triangulation analysis

Cited by 4 publications

References 44 publications

Nutrition and Non-Nutrition-Related Challenges Predict Time to Death in Long-Term Care Residents: A Retrospective Chart Review

Nutrition and Non-Nutrition-Related Challenges Predict Time to Death in Long-Term Care Residents: A Retrospective Chart Review

Uncovering Methods and Outcomes of Palliative Care for Geriatric Patients: A Scoping Review

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

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