Helping patients with advanced cancer live with concerns about eating: a challenge for palliative care professionals

This paper reports findings of an exploratory study of the eating habits of people with advanced cancer living in the south of England in 2003. The purpose of the study was to develop an understanding of why eating can be experienced as troubling and examine the potential for helping people live with the changes in eating habits that often accompany advanced cancer. Semistructured interviews were conducted with 30 patients, 23 lay caregivers, and 14 specialist nurses. The data were analyzed thematically. It was found that patients experienced eating-related concerns when the reality of eating differed from the expectations of eating. Patient response to concern ranged from acceptance to self-action. A subgroup of participants believed that they could have been helped by support for taking self-action. Eating-related concerns present nurses and other health care professionals with the challenge of supporting differing patient preferences for living with the symptom, which can include the expectation of support for self-action.

Purposful dehydration in a terminally ill cancer patient

The management of terminally ill patients who are unable to maintain their own hydration, or who express a wish to discontinue artificial hydration, is a significant controversial topic among healthcare professionals, patients and families. Evidence-based research suggests a number of medical and nursing indications and contraindications for dehydration. The purpose of this article is to review the current research, consider the factors involved in decision-making and clarify the complex issues which have implications for nursing surrounding the management of dehydration in terminally ill patients. The article uses the case of a patient nursed by the author and is written as a reflective account of practice.

Adults with terminal illness: a literature review of their needs and wishes for food

Food refusal can be a source of conflict between dying people and their caregivers. This review examines: the nature and purpose of food; some reasons for and implications of anorexia in terminal illness; ethical principles underpinning responses to declining appetite and food refusal; social transactions between dying people and their caregivers in relation to needs and wishes for food; and the need for further empirical research. The nature and purpose of food in human societies has been studied extensively by anthropologists but the knowledge gained is not often imported into health care practice, where eating is seen from a medical rather than an anthropological perspective. Food refusal may be a consequence of anorexia which is the result of physiological or psychological changes or it may be a deliberate choice in acceptance of impending death. Ethical principles underpinning responses to declining appetite and food refusal have been studied extensively and clear guidance obtained about what would be appropriate behaviour in given circumstances. There is little published empirical work on social transactions between dying people and their caregivers in relation to needs and wishes for food. As the contribution made to effective care-giving by high-quality interpersonal relationships is widely recognized, further knowledge about how best to sustain such relationships in these important circumstances would be useful. Moreover, as such interpersonal relationships often occur in an institutional context, it may be that more can be learnt from close examination of social transactions about how best to structure organizational processes to maximize autonomy and comfort for patients at the end of life. Further research is indicated.

Paediatric palliative care: a lack of research-based evidence

Providing the best possible care for the child and family is paramount to health professionals working in paediatric palliative care. However, there is little research which enables practitioners to question their current practice. There are concerns about conducting research on children receiving palliative care at such a sensitive time for the child and his/her family. These concerns must be considered against the growing demand for clear standards and guidelines for practice within health care. According to the Department of Health (DoH) there is no place within the modern healthcare system for the adoption of unproven theories or outdated care (DoH, 1998). While no-one would question the dedication and care being delivered to children and their families by well-trained staff, the lack of research is a cause for concern. A group of students undertaking a degree module in paediatric palliative care identified the lack of literature and research in this area and have undertaken a review of the available literature.