Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff

Authors

  • M. I. del Río,

    Corresponding author
    • Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • B. Shand,

    1. Departamento de Neurología, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • P. Bonati,

    1. Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • A. Palma,

    1. Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • A. Maldonado,

    1. Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • P. Taboada,

    1. Centro de Bioética, Pontificia Universidad Católica de Chile, Santiago, Chile
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  • F. Nervi

    1. Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile
    2. División de Medicina, Departamento de Gastroenterología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Programa de Medicina Paliativa y Cuidados Continuos, Pontificia Universidad Católica de Chile, Lira 44 Primer piso, Santiago, Chile. Email: delrio.ini@gmail.com

Abstract

Background

Decrease in oral intake, weight loss, and muscular weakness in the last phases of a terminal illness, particularly in the context of the cachexia–anorexia syndrome, can be an important source of anxiety for the triad of patient, family, and health staff.

Methods

The present literature review examines the emotional impact of reduced oral intake as well as perceptions and attitudes toward assisted nutrition and hydration for terminally ill patients1 at the end of life, among patients, family, and health care staff. We have identified the ways in which emotional and cultural factors influence decision-making about assisted nutrition and hydration.

Results

Lack of information and misperceptions of medically assisted nutrition and hydration can play a predominant role in the decision to begin or suspend nutritional or hydration support.

Conclusions

Our literature review reveals that these social, emotional, and clinical misperception elements should be considered in the decision-making processes to help the triad develop functional forms of care at this final stage of life. Copyright © 2011 John Wiley & Sons, Ltd.

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