Total parenteral nutrition for patients with advanced life-limiting cancer: decision-making in the face of conflicting evidence

Clay, Alison S.; Abernethy, Amy P.

doi:10.1179/096992608x257638

Cited by 3 publications

(1 citation statement)

References 52 publications

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“…The provision of palliative parenteral support (PPS) is currently considered controversial as a result of being associated with both prolonged survival 5 and complications resulting in prolonged hospital admissions. 6 Ethical considerations surrounding whether the provision of parenteral nutrition is considered a core component of compassionate care or a medical intervention add to the current controversy. 7,8 This is further confounded by systematic reviews into parenteral nutrition in palliative care currently being unable to determine evidence of clear benefit.…”

Section: Introductionmentioning

confidence: 99%

Availability of palliative parenteral nutrition to patients with advanced cancer: A national survey of service provision

Baker

Smith

White

et al. 2023

J Human Nutrition Diet

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Background Patients with advanced malignancy who are unable to meet their nutritional requirements orally or enterally as a result of intestinal failure may be considered for parenteral nutrition support. Current UK guidance recommends that patients with a 3‐month prognosis and good performance status (i.e., Karnofsky performance status >50) should be considered for this intervention at home (termed Home Parenteral Nutrition; HPN). However, HPN is a nationally commissioned service by National Health Service (NHS) England and Improvement that can only be initiated at specific NHS centres and so may not be easily accessed by patients outside of these centres. This survey aimed to identify current clinical practice across UK hospitals about how palliative parenteral nutrition is initiated. Methods Clinical staff associated with Nutrition Support Teams at NHS Organisations within the UK were invited to complete an electronically administered survey of national clinical practice through advertisements posted on relevant professional interest groups. Results Sixty clinicians responded to the survey administered between September and November 2020. The majority of respondents responded positively that decisions made to initiate palliative parenteral nutrition were conducted in alignment with current national guidance in relation to decision‐making and formulation of parenteral nutrition. Variation was observed in relation to the provision of advance care planning in relation to nutrition support prior to discharge, as well as the consideration of venting gastrostomy placement in patients with malignant bowel obstruction unsuitable for surgical intervention. Conclusions Adherence to current national guidance in relation to the provision of palliative parenteral nutrition is variable for some aspects of care. Further work is required particularly in relation to maximising the opportunity for the provision of advance care planning prior to discharge in this patient cohort.

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