26: Palliative/Hospice

Question 1

Is it appropriate to have palliative patients on EN or PN?

Answer 1

Depends on the situation. Might be contraindicated/aggressive if near the end of life, but patients be can on palliative treatment for months to years

Question 2

What are some symptom management strategies that might be encountered with palliative/hospice patients that are related to nutrition?

Answer 2

appetite loss – help families understand its normal condition of end of life and stimulants may only increase burden of another med to take

constipation – review standard recommendations – MD to could review pain management as well

Oral issues like dry mouth, taste loss, thrush, mouth sores – make sure good oral hygiene is getting met and then follow standard recommendations

Dysphagia – swallow eval might be viewed aggressive, but can help establish strategies for safe swallowing and diet modifications

Nausea – MD to review meds–perhaps compounded vs oral

wt loss – weighing the patient may cause distress for many reasons, is it possible to measure in other ways?

Question 3

What are recommendations for PN in a palliative situation?

Answer 3

If patients have intestinal obstruction or limited GI function, PN was found to increase survival time by 4 weeks and improved QOL, performance status and nutritional status when used for 1-3 months

But its effect on survival time was diminished with those receiving concurrent chemo