Critical Care Nurses' Perceptions of Parenteral and Enteral Nutrition at the End-of-Life in South Korea

Decision Making of Artificial Nutrition and Hydration for Cancer Patients at Terminal Stage-A Systematic Review of the Views From Patients, Families, and Healthcare Professionals

BACKGROUND

Decision making on nutrition and hydration for cancer patients during terminal stage cause critical impacts toward patient's comfort and living quality. The management of nutrition is the main dilemma that arises in these final situations and has been the subject of intense debate over the last few decades.

AIM

To find the views of patients, families, and healthcare professionals related to how decisions are made when cancer patients are at terminal stage.

DESIGN

This systematic review used PRISMA strategy to search and used Critical Appraisal Skills Programme checklist to evaluate the papers.

DATA SOURCES

All English papers through August 2020 that contained the view of the decision making at artificial nutrition and hydration with cancer patients, families, and healthcare professionals at terminal stage were included. Selected studies were independently reviewed, and data collaboratively synthesized into core themes.

RESULTS

Most of the terminal stage cancer patients and their families initially started the decision-making process when facing the reduction of oral intake. There are two primary considerations of patients and families, one is for prolonging patients life, and the other is to maintain their life quality. The voices of patients were influential, but not determinative; families usually had influence, but seldom make the final recommendation by themselves; healthcare professionals frequently face the dilemma about their decision.

CONCLUSION

The decision of nutritional support was dynamic; the interaction between patients and families frequently be hesitated to protect the rights of life, unnecessarily prolonging lifetime. Therefore, a better understanding of the views on nutritional support and processing the clinical guideline of decision making for healthcare professional is necessary.

Nurse and Nursing Students´ Opinions and Perceptions of Enteral Nutrition by Nasogastric Tube in Palliative Care

It is widely accepted that nursing staff play a key role in palliative care (PC). The use of Nasogastric tubes (NG tubes) for Enteral Nutrition (EN) administration is still controversial in patients who receive PC. The aim of this study was to describe nurses' and nursing students´ opinions and perceptions about EN using NG tubes in adult patients in palliative care. To achieve this goal, a cross-sectional descriptive study was carried out. A self-administered, semi-structured questionnaire intended for nurses and nursing students was used. Data was descriptively and inferentially analyzed using a chi-square test to determine the differential frequency of responses. In addition, a multivariate logistic regression model was also conducted. A total of 511 participants completed the questionnaire. Among them, nursing staff represented 74.9% (n = 383) whereas nursing students were 25.1% (n = 128). When life expectancy was above six months, 90.0% (n = 460) reported that EN using NG should be implemented. In contrast, when life expectancy is less than a month, 57.5% (n = 294) discouraged it. Significant differences within groups were found when life expectancy was <1 month (p = 0.044). It was also found that 491 participants (96.1%) reported that patient´s autonomy must be carefully respected for deciding whether continuing EN by NG tube or not. Finally, it was concluded for both nurses and nursing students that life expectancy should be the mean reason for implementing and withdrawing EN by NG tube. Major differences were found regarding when it should be ceased, suggesting perceptions may change as nurses graduate and move into their professional roles.