Hospice care necessitates painful talks and decisions between healthcare providers, patients, and families. Initiating, sustaining, or removing artificial nutrition and hydration (ANH) as a patient nears death is one of the most difficult topics.
Such decisions are difficult by multiple medical guidelines and ethical issues. Patients’ and families’ emotions, their difficult questions regarding withholding food and water at the End Of Life Care In San Francisco, and the religious, cultural, spiritual, and personal influences surrounding a loved one’s impending death.
Healthcare workers may negotiate these challenging issues by engaging in dialogues informed by their extensive medical-clinical knowledge and guided by empathy.
Create a Personalized Hospice Care Plan
Advance care planning is the optimal method for elucidating a patient’s wishes and values before the patient’s incapacity to communicate them. Clinicians can educate patients and their families about natural death, particularly the function of ANH. So that medical, ethical, and professional standards are met. The hospice care team can be an invaluable resource for facilitating such dialogues.
Because each patient’s condition, goals of care, and needs are unique, decisions regarding ANH should always made following a careful, forthright, and informative conversation addressing:
- Specific diagnosis and prognosis for the patient: How do nutrition and hydration impact both?
- What are the indications for or contraindications against ANH?
- What are the patient’s and their family’s personal, cultural, and religious views and values? How may their wishes be respected within the hospice care plan?
- Will artificial feeding and hydration increase or alleviate human suffering?
- Will care-related decisions respect the patient’s preferences and values?
Inform relatives about the dying process
Current research does not support the claim that withholding food and drink at the end of life increases misery and lengthens life. Such evidence should incorporated into discussions about care goals and creating a customized hospice care plan. As the patient’s condition evolves, so should the hospice care plan.
Doctors and nurses must also address emotional concerns by assuring families that hospice patients who stop eating. Or drinking are not “given up” or “starving.” Instead, professionals should inform patients and families about the body’s natural dying process, which involves the cessation of digestion and an increasing inability to process food and fluids. Families might take comfort in that when a patient’s food and fluid intake decreases. The body frequently releases “feel-good” endorphins as a natural pain treatment.
Tube Placement: Advantages against Dangers/Complications?
General feeding tube instructions for hospice patients:
Existing feeding tube: If patients are admit to hospice with feeding tubes in situ, doctors should collaborate closely with patients, families, and caregivers to determine if and when ANH should be decrease or discontinued.
As the end of life approaches. ANH may contribute to discomfort, aspiration, and the development of pressure sores without extending longevity.
Once a patient is engaged in hospice care, feeding tubes are frequently not inserted. In rare cases, making a feeding tube placement choice is in collaboration with the patient, family, and hospice interdisciplinary team.
Studies indicate that ANH does not improve or prolong life. But it is associated with several problems that reduce the patient’s quality of life.
Common risks include irritation, infection, blockage, discomfort, aspiration pneumonia, bleeding, reflux, uncontrolled diarrhea, limited socialization/movement, frequent tube replacement/removal, insufficient dental care, and increasing physical and pharmacological restraints. End-of-life tube feeding can also cause patients to feel “drowning” or unpleasant fullness.
The American Geriatric Society, American Academy of Hospice and Palliative Medicine, and The Society for Post-Acute. Long-Term Care Medicine does not suggest feeding tubes for patients with severe Alzheimer’s/dementia as an example of diagnosis-dependent guidelines. Oral aided feeding is recommended instead.
Common Questions from Healthcare Professionals Regarding ANH towards the End of Life
Are feeding tubes effective in preventing malnutrition? Perhaps not necessarily. Many individuals on hydration and feeding tubes continue to endure malnutrition due to the underlying disease. Immobility, and neurologic impairments, and not due to a lack of food/water.
Do feeding tubes prevent or accelerate the healing of pressure ulcers? Artificial nutrition/hydration can increase urine output, feces, diarrhea, upper airway secretions, and immobility, which can worsen pressure ulcers or impede their healing.
Do feedback tubes reduce the rate of mortality? According to research, the life expectancy of patients who are provided end-of-life ANH is comparable to those who are not.
Are feeding tubes effective in preventing aspiration pneumonia? The available evidence does not indicate that feeding tubes reduce the risk of aspiration pneumonia or regurgitation of gastric contents.
According to some studies, patients with tubes can still aspirate stomach contents and oral secretions or get aspiration pneumonia from other organic reasons.
Inform families regarding end-of-life care
Recommended that healthcare experts encourage family members to adhere to approved hospice recommendations for food and water at the end of life.
If the patient can still eat or drink, offer little sips of water/liquids, ice chips, hard sweets, or small portions of food with a spoon. Take your cues on when to stop from the patient.
If a patient cannot drink, keep their lips and mouth moist with swabs, a damp washcloth, lip balm, or moisturizers.
Encourage family members to provide different types of sustenance, such as conversation, loving touch, music, singing, poetry, humor, visits from pets, gentle massage, reading, prayers, and other caring and loving activities.