Oncology and Palliative Care Nurses' Knowledge and Attitudes Toward Artificial Nutrition and Hydration for Patients at End of Life in Italy: A Cross-sectional Survey

Healthcare Professionals' Knowledge, Attitudes and Practices Toward Providing Artificial Nutrition and Hydration for Patients With Terminal Cancer

BACKGROUND

Decisions related to artificial nutrition and hydration (ANH) provision for patients with terminal cancer are a complex topic that can affect the patients' quality of life (QoL). This study aimed to investigate the knowledge, attitudes and practices of healthcare professionals (HCPs) in South Africa concerning the provision of ANH for patients with terminal cancer.

METHODS

This descriptive, cross-sectional study with an analytical component, involved doctors, nurses and dietitians experienced in caring for patients with terminal cancer. Data were collected via an electronic platform (n = 151), utilising a validated questionnaire with close-ended questions. Statistical analysis was performed using Statistica Version 14.0, with p < 0.05 indicating statistical significance.

RESULTS

Notable disparities were observed in HCPs' knowledge, attitudes and practices related to ANH provision. Participants demonstrated a high level of knowledge about palliative care (PC) (92%) but scored lower for ANH provision (56%). Most participants were aware of the burdens associated with ANH provision (mean score: 4.1 ± 0.7 [5-point Likert scale]), yet optimism emerged regarding its perceived psychological benefits. Factors such as patient autonomy (4.5 ± 0.8) and communication between the medical team and patients (4.4 ± 1.0) appeared to influence HCPs' practices. Furthermore, a notable difference was observed in knowledge scores and attitudes based on certain socio-demographic variables.

CONCLUSION

This study suggests that HCPs have inadequate knowledge about, and contradictory attitudes toward, ANH provision in patients with terminal cancer. The study highlights the need for targeted education on terminal care, thereby informing efforts to improve the overall quality of care of these patients.

Enhancing nutritional care in palliative care units: assessing nurse knowledge and quality perception in enteral nutrition practices

BACKGROUND

Adequate, balanced, and individualized nutrition, planned according to the patients' life expectancy in palliative care units, is crucial for maintaining essential functions.

AIM

To determine the knowledge levels of nurses working in palliative care units regarding enteral nutrition practices and their perceptions of nutritional care quality in their units.

METHODS

This descriptive, cross-sectional study was conducted in 25 palliative care units located in Izmir, Türkiye, between June and September 2022. The study sample consisted of 205 nurses working in palliative care units. Data were collected using a Personal Information Form, an Enteral Nutrition Practices Knowledge Form, and the Nurses' Perceived Nutrition Care Quality Assessment Scale. The STROBE checklist was also utilized.

RESULTS

The study found that the majority of participating nurses (94.6%) were female, with 78.5% holding bachelor's degrees. The median knowledge score for enteral nutrition: 15 (range: 2-27), perceived care quality score: 36 (range: 9-45). Those with enteral nutrition training had significantly higher knowledge scores (p < .001); palliative care certificate showed no difference (p = .846). Nurses lacking nutrition counseling knowledge had lower perceived care quality scores (p = .001). Monthly tube feeding applications correlated positively with knowledge scores (r = .173, p = .013), unlike professional experience duration (p = .126) and time spent in palliative care (p = .839).

CONCLUSION

Nurses working in the palliative care unit find the quality of nutrition care provided to patients in their clinics to be sufficient, and the level of knowledge regarding enteral nutrition is at a moderate level. However, in questions related to nursing care such as fluid requirements during enteral nutrition with enteral solutions that affect both nutritional care and medical treatment, maintaining the opening of the jejunostomy tube, and enteral drug administration, correct response rates were low. Low correct response rates on specific issues highlight a need for targeted educational interventions.

The Clinical Value of Nutritional Care before and during Active Cancer Treatment

Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients' overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients' nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.