Chapter 26: Palliative/Hospice

Question 1

With hospice, ________ services are offered to families before and for up to 1 year after a patient’s death

Answer 1

bereavement

Question 2

Lifespan estimate for hospice to be covered by medicare/medicaid

Answer 2

6 months or less

Question 3

Referral to palliative care is recommended within _______ weeks of an advanced cancer diagnosis

Answer 3

8

Question 4

T/F: Many MNT interventions designed to manage digestive and oral symptoms in order to improve the enjoyment/tolerance of food are palliative in nature

Answer 4

True

Question 5

3 goals of RD in palliation

Answer 5

1. Symptom management
2. Educate patient/family on nutrition recommendations
3. Assist with decisions regarding use of artificial nutrition/hydration

Question 6

_______% of advanced cancer patients in hospice care have taste/smell abnormalities, impacting food enjoyment & QOL

Answer 6

93%

Question 7

Top 5 nutrition impact symptoms in advance cancer (palliative setting)

Answer 7

1. Xerostomia
2. Loss of appetite
3. Wt loss
4. Early satiety
5. Constipation

(Diarrhea, nausea, dysphagia less common but prevalent)

Question 8

Besides specific GI/oral issues, ____ & _____ can significantly impact eating as a result

Answer 8

Pain, fatigue

Question 9

Comment on appetite stimulants with EOL

Answer 9

Only increase burden in taking meds, appetite loss is a normal condition at EOL

Question 10

Ensure _________ for dry mouth, dysguesia, mouth sores w/ hospice

Answer 10

Good oral hygiene

Question 11

Are swallowing evals recommended w/ QOL

Answer 11

Yes, although it may seem aggressive it may be useful to establish strategies for safe swallowing

Question 12

When oral antiemetics are difficult PO to take at EOL, _______ administration should be considered

Answer 12

Topical

Question 13

Monitoring wt may be stressful at the end of life, consider more indirect measures like ___________

Answer 13

Arm circumference

Question 14

_______ is the standard of screening for oncology patients

Answer 14

PG-SGA

Question 15

D/t close correlation, besides traditional nutrition screening tools, ______ & _____ assessments performed in hospice settings may be useful tools to identify those who would benefit from nutrition intervention

Answer 15

QOL & functional `

Question 16

What are the 3 principles of comfort feeding?

Answer 16

1. Offer appropriate & favorite foods
2. Assist without force
3. Recognize signs of satiety or refusal

Question 17

What are some more MNT-based interventions that may help QOL?

Answer 17

Low salt for fluid retention, wound healing, DM management

Question 18

With palliative care, artificial nutrition is commonly used when bowel obstruction prevents an oral diet, most commonly in patients with _____ cancer

Answer 18

Ovarian

Question 19

Use of artificial hydration when patients are getting palliative care, both while receiving treatment versus comfort care

Answer 19

Hydration is crucial while still getting treatment and artificial hydration is often used

when not under treatment, if a pt is dehydrated focus on palliating the symptoms. Comfort.

Question 20

ASPEN’s stand on EN/PN during EOL

Answer 20

Rarely indicated

Question 21

Other countries may recommend offering PN if Karnofsky score is > ____ or if ECOG is </=

Answer 21

50
2