Nutrition in Palliative Care (Week 9 Lecture 1) Flashcards
Cancer nutrition
High protein: 1.3 grams per kg body weight to start (body needs protein for healing and strength for treatment)
High calorie: 25-35 calories per kg or more.
(For most, but not all cancer types)
Definition of palliative
Relieving or soothing the symptoms of a disease or disorder without effecting a cure.
* May be days, weeks, months, years
EOL palliative care
Palliative care is the special care of a person whose disease cannot be cured. Palliative care provides comfort and support to the person and family. Palliative care does not hasten or delay death. The goals of palliative care are to: ease pain and other symptoms (such as depression, upset stomach), help the person to have a clear mind and support the person, family and friends.
How does pain impact ability to eat?
- ability to prepare meals
- directly affects appetite
- pain medications can cause constipation, reducing intake
- ongoing pain can lead to depression and in turn lead to reduced appetite
- affects ability to grocery shop
- pain medication can limit ability to drive and buy groceries
- fear of pain with eating
- fear of pain with bowel movements
- removes satisfaction and joy of eating
Common nutrition complaints in palliative care
- Early satiety
- Weight loss
- Constipation
- Diarrhea
- Bloating
- Abdominal pain
- Ascites
- Fatigue
- “im just not hungry”
What makes palliative care complex?
- How long do they have to live? Just how “palliative” are they?
- What is their understanding of their illness and prognosis? Further
treatment? - What is the main symptom affecting their ability to eat? Can I change that?
- Are any of our recommendations likely to make a difference?
- Is it worth the fighting? (fighting with family to eat more when it really won’t change the outcome)
What is the understanding of their illness and prognosis?
Grief —> denial —> anger —depression —> bargaining —> acceptance
* Not dieticians job to covince someone they are dying.
How long do they have?
- If they are still receiving treatments for which they need strength - push patients a little bit harder for oral intake and help them to undertand that they need nutrition and strength to get through the treatment
- End of life, likely suggestions will be made to family members (as opposed to the pt) to help ease end of life care and acceptance of the fact they are not eating- and that’s okay. QoL matters most here
What is the main symptom
affecting their ability to eat?
- early satiety - ask about BM frequency (appearance, size), fluid intake, abdominal symptoms
- constipation - ask about bowel routine and medications, discuss fibre intake
- nausea/vomiting- ask about antiemetics and bowel frequency, fluid intake
- pain - we give written information, change medications and follow up repeatedly until stable
So, what do you do if a patient has been eating really well but is still losing weight?
they are experiencing cancer cachexia and very little you do can stop that. And that’s okay.
* Mostly just encouraging to keep doing what they are doing.
* Let them know it is normal and what happens in advanced cancer and unfortunately to be expected
Is it worth the fight?
Food = love
Feels like ‘giving up’ for family
Goal then is reducing strain on relationships at end of life
What can you suggest to the family to reduce strain?
Take a step back.
* tidy their house
* quality time together some sort of activity
* help them write memoirs
* tell stories
Dieticians approach to palliative care
- Keep your goals simple and appropriate
- Limit your goals of the visit to one or two points
- Provide suggestions, not rules
- Allow a patient to be in charge of their own outcomes
- Don’t mention weight loss or appearance in EOL care. (can be triggering)
Role of compassion in palliative care
Most important thing
* Compassion optimally involves a quality of presence that conveys stability and resilience, with a balanced concern and heartfelt connection, but is not depleting or overwhelming to either person.
* caregiver - not giving up oneself to care for someone else (burnout)
Preventing moral distress
- Use compassion. Think logically, not emotionally.
- Get only the amount of personal information you require for your job, and no more.
- Your job is to provide information only.
- Allow a patient to make their own choices in their care.
- Make a patient accountable to themselves, not you.
