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Weaver MS, Geppert CMA. Sometimes a difficult decision to swallow: Ethical dilemmas when patients with dysphagia who lack capacity want to eat. J Pain Symptom Manage 2023; 65:e97-e102. [PMID: 36272543 DOI: 10.1016/j.jpainsymman.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Meaghann S Weaver
- VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA; Department of Pediatrics (M.S.W.), University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Cynthia M A Geppert
- VHA National Center for Ethics in Health Care (M.S.W., C.M.A.G.), Washington, District of Columbia, USA; Departments of Psychiatry and Internal Medicine (C.M.A.G.), Ethics Education, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
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Worthington P, Balint J, Bechtold M, Bingham A, Chan LN, Durfee S, Jevenn AK, Malone A, Mascarenhas M, Robinson DT, Holcombe B. When Is Parenteral Nutrition Appropriate? JPEN J Parenter Enteral Nutr 2017; 41:324-377. [PMID: 28333597 DOI: 10.1177/0148607117695251] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings.
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Affiliation(s)
| | - Jane Balint
- 2 Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio, USA
| | | | - Angela Bingham
- 4 University of the Sciences, Philadelphia, Pennsylvania, USA
| | | | - Sharon Durfee
- 6 Central Admixture Pharmacy Services, Inc, Denver, Colorado, USA
| | | | | | - Maria Mascarenhas
- 9 The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel T Robinson
- 10 Ann & Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Beverly Holcombe
- 11 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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3
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Affiliation(s)
- Albert Barrocas
- Chief Medical Officer, South Fulton Medical Center, 1170 Cleveland Ave., East Point, GA 30344, USA.
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4
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Wallin V, Carlander I, Sandman PO, Ternestedt BM, Håkanson C. Maintaining ordinariness around food: partners’ experiences of everyday life with a dying person. J Clin Nurs 2013; 23:2748-56. [DOI: 10.1111/jocn.12518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Viktoria Wallin
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Skondal University College and Ersta Hospital; Stockholm Sweden
- Department of Learning; Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Per-Olof Sandman
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
| | - Britt-Marie Ternestedt
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Research, Development and Education Unit; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Cecilia Håkanson
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
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Fritzson A, Tavelin B, Axelsson B. Association between parenteral fluids and symptoms in hospital end-of-life care: an observational study of 280 patients. BMJ Support Palliat Care 2013; 5:160-8. [DOI: 10.1136/bmjspcare-2013-000501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/10/2013] [Indexed: 11/03/2022]
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6
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Shaw C. Nutrition and Palliative Care. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shaw C, Power J. Nutritional Support for the Cancer Patient. Nutr Cancer 2013. [DOI: 10.1002/9781118788707.ch8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Holmdahl S, Sävenstedt S, Imoni R. Parenteral nutrition in home-based palliative care: Swedish district nurses experiences. Scand J Caring Sci 2013; 28:89-96. [DOI: 10.1111/scs.12038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 02/11/2013] [Indexed: 10/27/2022]
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Barrocas A, Geppert C, Durfee SM, Maillet JO, Monturo C, Mueller C, Stratton K, Valentine C. A.S.P.E.N. Ethics Position Paper. Nutr Clin Pract 2010; 25:672-9. [DOI: 10.1177/0884533610385429] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Alvarez Hernández J. [Parenteral nutrition at home]. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2010; 57:287-289. [PMID: 20580330 DOI: 10.1016/j.endonu.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 04/12/2010] [Accepted: 04/16/2010] [Indexed: 05/29/2023]
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Abstract
The withdrawal, withholding, or implementation of life-sustaining treatments such as artificial nutrition and hydration challenge nurses on a daily basis. To meet these challenges, nurses need the composite skills of moral and ethical discernment, practical wisdom and a knowledge base that justifies reasoning and actions that support patient and family decision making. Nurses' moral knowledge develops through experiential learning, didactic learning, and deliberation of ethical principles that merge with moral intuition, ethical codes, and moral theories. Only when a nurse becomes skilled and confident in gathering empiric and ethical knowledge can he or she fully act as a moral agent in assisting families faced with making highly emotional decisions regarding the provision, withholding, or withdrawal of artificial nutrition and hydration.
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Affiliation(s)
- Cheryl Monturo
- West Chester University College of Health Sciences, Department of Nursing, 222C Sturzebecker Health Sciences Center, West Chester, PA 19383, USA
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12
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Orrevall Y, Tishelman C, Permert J, Cederholm T. The use of artificial nutrition among cancer patients enrolled in palliative home care services. Palliat Med 2009; 23:556-64. [PMID: 19477887 DOI: 10.1177/0269216309105811] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, patients' views and experiences of using home artificial nutrition, and factors associated with use of home parenteral nutrition (HPN) were investigated. Structured telephone interviews with 620 cancer patients enrolled in 21 palliative home care services were analysed. HPN was more common (11%) than home enteral tube feeding (HETF, 3%). Home artificial nutrition (including HPN and HETF) was usually introduced more than four months before death. Three of four HPN recipients also had oral food intake. HPN use was associated with eating difficulties, nausea/vomiting, and fatigue rather than gastrointestinal problems per se. HETF was generally used for patients with problems related to oesophagus and head and neck tumours. In conclusion the results suggest that, contrary to existing guidelines, HPN is used to supplement oral intake, and not only for patients with a non-functioning gastrointestinal tract.
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Affiliation(s)
- Y Orrevall
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
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Practice Paper of the American Dietetic Association: Home Care—Opportunities for Food and Nutrition Professionals. ACTA ACUST UNITED AC 2009; 109:1092-100. [DOI: 10.1016/j.jada.2009.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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