Decision-making about artificial feeding in end-of-life care literature review

Or is it because of the emotionally laden content of any discussion of withholding nutrition or hydration, albeit artificial, from patients? ANH are easily conflated with the act of normal feeding, as of an infant, with all of its attendant symbolism of caring and love.

But ANH have little in common with eating a normal meal around the dinner table with loved ones.

In fact, ANH may further isolate patients from human contact and its attendant acts of caring. Yet, research indicates that when presented with all the relevant facts, patients and families generally opt to forgo more aggressive interventions when benefits are marginal.

End Of Life Care articles: The New England Journal of Medicine

This article explores the medical aspects of ANH, including the indications, contraindications, effects, side effects, and toxicities, as well as alternative treatment interventions. A framework is presented for having these challenging discussions with patients and families in a supportive way that augments autonomous informed decision-making on the part of patients and families.

Resources for health professionals and for patients and families are included. In the writing a good essay intro, her clinical presentation and chest X-ray are consistent with aspiration pneumonia.

She is started on appropriate antibiotics to treat the pneumonia, and her clinical condition improves over the course of several days. The attending physician orders a swallow study and a nutrition consultation, which confirms that the patient has severe dysphagia, with aspiration.

Her family expresses concern that, if Edith is unable to swallow, she will starve to death, and ask about a feeding tube placement. Medical Overview Definitions Artificial hydration: Administration of fluid through nonoral means; routes include intravenous or subcutaneous also called hypodermoclysisrectal proctoclysisand enteral. Nonoral, mechanical feeding either by intravenous or enteral route.

Enteral feedings may be provided through either nasogastric tubes or gastrostomy, esophogostomy, or jejunostomy tubes that are placed either endoscopically or in open surgical procedures.

Artificial Nutrition and Hydration: Having the Conversation

Intravenous nutrition is administered through a central line and feeding is called review parenteral nutrition TPN. What are the intended effects and side effects? Do the benefits outweigh the harms? Consider the artificial clinical scenarios. Enteral Feeding for Patients With End-Stage Dementia It is certainly not uncommon for patients with far advanced dementia to be transferred to the hospital for treatment of aspiration pneumonia related to the onset of dysphagia.

All too often, after treating the pneumonia appropriately, the default literature, often with very little discussion with patient and family, is to arrange for placement of a feeding gastrostomy tube. Unfortunately, the body of the research evidence fails to substantiate that any of these goals is achieved through enteral tube placement in patients care advanced dementia. Some studies even suggest increased mortality results when compared with conservative management.

There decision-making, business plan for aviation mro, exceptions about ANH may provide net benefit, such as in the cancer patient with a good performance status experiencing hunger in the face of nonfunctional bowel due to radiation enteritis, bowel obstruction proximal or distal from tumor, head and neck cancer with destruction of oropharynx, or infiltration of bowel wall due to metastasis.

In such cases, where consistent with individual end-of-life goals and duly considering possible harms, a time-limited trial of ANH could be initiated, and goals revisited periodically to see whether they have been achieved through the intervention. Some patients will want a trial of ANH to see whether their goals can be met.

Other patients may not want this intervention, if it is viewed as only prolonging suffering and the dying process.

Oncology Nursing Society | CJON

What does the patient want to achieve, and is ANH likely or unlikely to achieve it? What do we know currently? Does artificial hydration effectively relieve thirst in seriously ill dying patients? Does artificial hydration extend life? Does artificial hydration alleviate delirium or other distressing symptoms? Research is difficult to conduct in this frail, vulnerable population, hence the paucity of well-designed studies examining these specific questions.

It has been fairly well established that intravenous fluid is not an effective intervention for relief of thirst. More effective interventions are keeping the mouth and mucous membranes moist with frequent small sips of fluid or introduction of ice chips into the oral cavity, as well as maintaining good oral hygiene.

In fact, some studies seem to indicate that patients receiving hospice and palliative care live longer than matched controls, so perhaps it can be inferred that artificial hydration administered when the person is close to death is unlikely to extend life. Some experts posit that dehydration may actually improve comfort through the release of endorphins, noting the ease with which frail elders can slip into a dehydrated state unnoticed due to lack of troubling symptoms other than decreasing level of consciousness.

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That's because if CPR is successful, they can expect to recover, leave the hospital, and continue with their active lives for a reasonable period of time. Some elderly homework slips requirements terminally ill people who have become incurably frail might decide not to have measures instituted that will either only extend their lives in a vegetative state or result in their being senseless because of their specific medical condition.

Some people decide that they won't want CPR and respirators once they can no longer remember the names of their children or their own names. Why would someone want CPR? Some people might make the opposite decision.

They might decide to have CPR and machines to support artificial breathing because they want to live as long as possible. If you make a decision like that, it will be respected by doctors and hospitals. The doctor is decision-making to make a reasonable decision about which cares might help and are reasonable. The input of the patient in this process is very important. Your personal and end-of-life beliefs will influence these decisions. Deciding to forgo life-sustaining treatment.

US Government Printing Office; By no extraordinary means: Indiana University Press; Siegler M, Weisbard AJ. Against the emerging stream: On care the dying. PubMed Google Scholar Guidelines on the termination of life-sustaining treatment and the care of the dying. Lo B, Dornbrand L. Understanding the benefits and decision-making of tube feedings.

Nancy Cruzan and the right to die. Health care proxies, living wills, and durable powers of attorney. Tube feeding in patients with advanced dementia.

Rethinking the role of tube about in patients with feeding dementia. Survival analysis in percutaneous endoscopic gastrostomy feeding: Feeding alternatives in thesis electricity market with dementia: Artificial nutrition and literature at the end of life: Enteral and artificial review in terminally ill end-of-life patients: Am J Hosp Palliat Care.

Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Complications of feeding literature. Appropriate use of artificial nutrition and hydration—fundamental principles and recommendations. The difficulties of swallowing at the end of life.

The process of dying mesopotamia thesis statement and without feeding and fluids by tube. Law Med Health Care.

Is withdrawing hydration a valid review measure in the terminally ill?