Palliative care is an approach that improves the quality of life of individuals and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (WHO definition of palliative care).
- There are 3 types of nutritional support which relate to different life stages:
- Curative – where treatment is aggressive and aimed at eliminating the disease or curing the patient, with prolongation of life and survival being the aims during this phase
- Palliative – where cure is not an expected outcome, but the aim is to improve the quality of life through symptom control and management
- Terminal – where death appears to be inevitable or imminent and management is aimed solely at comfort.
- (DAA background paper: Nutrition priorities in palliative care of oncology patients. Australian Journal of Nutrition and Dietetics 1994; 51:2;88-92
Nutrition and hydration are important throughout all of the above life stages, including end of life. It can be a confusing and a difficult time for all.
There is often conflict about nutrition in the palliative phase. On the one hand, the family, friends, carers focus on the provision of food and fluids as an act of love. Providing food is one thing that they can do when all other aspects of their loved one’s care is out of their control. At the same time, the individual feels tension because they are grateful for the food offered, but are unable to eat and drink as they have in the past, and this can result in guilt because they can feel how stressed their family and friends are about their poor intake.
At this time there are often a number of problems that may be contributing to poor oral intake, including:
- reduced appetite
- Nausea and vomiting
- Sore mouth and throat
- Difficulty swallowing
- Dry mouth
- Loss of taste, smell
- Altered tastes, smell
- Diarrhoea, constipation
It is important to reach a stage where both parties are aware of the issues involved, and can come to a compromise about how nutrition and hydration will be managed, so that everyone can enjoy quality time together. Importantly, nutrition and palliative care must be a team approach which includes the individual, family, friends, carers, nurses, GP’s, members of the allied health team, such as Dietitian’s, Speech Pathologists, and the food services team.
Where palliative and terminal care are concerned, nutrition and hydration is less about the 5 core food groups and nutritional balance and adequacy, and more about the provision of food and fluids that are in keeping with the individual and family/ carer preferences, to achieve comfort and the best quality of life that is possible.
It is important that the focus of food be upon offering foods that the individual enjoys, in quantities that they are able to manage. Some of the following tips may be helpful
- Often small, frequent meals and snacks are better tolerated than larger main meals. A few mouthfuls at a time can work wonders
- Improve the quality of food rather than focusing on the quantity
- Offer foods high in protein where possible, including milk and dairy, meat, fish, chicken, eggs, baked beans etc
- Ensure a variety of fluids are offered during the day
- Offer fluids rather than food if they are better tolerated – include milkshakes, juices, spiders, cordials, soft drinks, water
- Ginger ale is often helpful to assist with nausea
- “Go with” the tastes that are requested – it’s perfectly fine to eat sweet foods if that’s what is being asked for
- Cold foods are often better tolerated than hot foods
- Foods with less odour may be better tolerated
- Offer “favourite” foods rather than “nutritionally sound” foods
- Offer foods at a time when the individual is more alert
- Ensure the correct texture of food is provided to assist with eating. A Speech Pathologist may help with assessing the safest texture.
- Provide feeding assistance as requested, required and interact while feeding
- Ensure the meal, snack times are enjoyable and maintain a social atmosphere at meal times
- Ensure the meals and snacks are attractive, appetising and tasty
Most of all, respect the individual’s right to choose how they will eat and drink.
While it is preferable to try food first, nutritional supplements can provide nutritional assistance where required.
It’s a privilege to share in someone’s final journey – embrace your part in it.