In spite of the existence of clinical guidelines and a legal framework in France, the withdrawal of artificial nutrition (AN) in palliative care remains a difficult situation for caregivers who are confronted with this reality.
Objectives:
To describe the perception of caregivers on the withdrawal of AN and to compare this perception between caregivers who have already been confronted with this situation and those who have not.
Methods:
Cross-sectional survey questionnaire of nurses and nurses’ aides (n = 274) working in medicine, surgery, and palliative care departments of a regional hospital.
Results:
Of the caregivers, 59.5% declared having been confronted with the withdrawal of AN in their professional practice. This was associated with a better perception by these caregivers even if their knowledge on the criteria to be considered in the decision was not significantly modified.
Conclusion:
The coherence of the withdrawal of AN with the personal beliefs of the caregivers, already high in the absence of being confronted with this practice, is better among caregivers who have been confronted with this situation. The lack of information perceived by caregivers should prompt us to develop additional training on the withdrawal of AN, its objectives, and its clinical consequences.
CraigGM. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far?J Med Ethics. 1994;20(3):139–143; discussion 44-45.
2.
WilkesE. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A commentary. J Med Ethics. 1994;20(3):144–145.
3.
DunlopRJEllershawJEBainesMJSykesNSaundersCM. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? A reply. J Med Ethics. 1995;21(3):141–143.
4.
BozzettiFAmadoriDBrueraE. Guidelines on artificial nutrition versus hydration in terminal cancer patients. European association for palliative care. Nutrition. 1996;12(3):163–167.
5.
RipamontiCTwycrossRBainesM. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9(4):223–233.
6.
BachmannPMarti-MassoudCBlanc-VincentMP. Summary version of the Standards, options and recommendations for palliative or terminal nutrition in adults with progressive cancer (2001). Br J Cancer. 2003;89suppl 1:S107–S110.
7.
SolomonMZO'DonnellLJenningsB. Decisions near the end of life: professional views on life-sustaining treatments. Am J Public Health. 1993;83(1):14–23.
8.
MicetichKCSteineckerPHThomasmaDC. Are intravenous fluids morally required for a dying patient?Arch Intern Med. 1983;143(5):975–978.
9.
AschDAChristakisNA. Why do physicians prefer to withdraw some forms of life support over others? Intrinsic attributes of life-sustaining treatments are associated with physicians' preferences. Med Care. 1996;34(2):103–111.
10.
MoritaTShimaYAdachiIJapan Palliative Oncology Study Group. Attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol. 2002;20(24):4699–4704.
11.
DupontB. Loi leonetti: lecture philosophique, inquiétudes éthiques. Méd Palliat. 2007;6(2):99–103.
12.
DenoyelBPerrinM. Nutrition parentérale en phase terminale de cancer, quelles indications?Méd Palliat. 2006;5(3):123–130.
13.
GérardinM. La nutrition artificielle: quel bénéfice pour le patient?Laennec. 2006;54(3):6–13.
14.
VerspierenP. Alimentation, éthique et fin de vie. In: RapinC ed. Des années à savourer. Lausanne: Payot; 1993:261–268.
15.
RosnerFAbramsonN. Fluids and nutrition: perspectives from Jewish law (Halachah). South Med J. 2009;102(3):248–250.
16.
BrodyHHermerLDScottLDGrumblesLLKutacJEMcCammonSD. Artificial nutrition and hydration: the evolution of ethics, evidence, and policy. J Gen Intern Med. 2011;26(9):1053–1058.
17.
GielenJBhatnagarSMishraS. Can curative or life-sustaining treatment be withheld or withdrawn? The opinions and views of Indian palliative-care nurses and physicians. Med Health Care Philos. 2011;14(1):5–18.
18.
WurzbachME. Long-term care nurses' moral convictions. J Adv Nurs. 1995;21(6):1059–1064.
19.
MahoneyMARileyJMFrySTFeildL. Factors related to providers' decisions for and against withholding or withdrawing nutrition and/or hydration in adult patient care. Online J Knowl Synth Nurs. 1999;6:4.
20.
MiyashitaMMoritaTShimaYKimuraRTakahashiMAdachiI. Nurse views of the adequacy of decision making and nurse distress regarding artificial hydration for terminally ill cancer patients: a nationwide survey. Am J Hosp Palliat Care. 2007;24(6):463–469.
21.
AndrewsMRLevineAM. Dehydration in the terminal patient: perception of hospice nurses. Am J Hosp Care. 1989;6(1):31–34.
22.
KeLSChiuTYHuWYLoSS. Effects of educational intervention on nurses' knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients. Support Care Cancer. 2008;16(11):1265–1272.
23.
YamagishiATanakaFMoritaT. Artificial hydration therapy for terminally ill cancer patients: a nurse-education intervention. J Pain Symptom Manage. 2009;38(3):358–364.
24.
KinzbrunnerBM. Ethical dilemmas in hospice and palliative care. Support Care Cancer. 1995;3(1):28–36.
25.
ChiuTYHuWYChengSYChenCY. Ethical dilemmas in palliative care: a study in Taiwan. J Med Ethics. 2000;26(5):353–357.
26.
VachonML. Staff stress in hospice/palliative care: a review. Palliat Med. 1995;9(2):91–122.
27.
DevaloisBGinestonLLeysA. Controverse “peut-on ou non discuter d'un éventuel arrêt de la nutrition/hydratation médicalement assistée ou doit-on les considérer comme des soins “de base” ?”. Méd Palliat. 2008;7(4):222–228.
28.
VerspierenP.Controverse: “l'alimentation: un traitement ou un soin?”. Réflexion éthique. Méd Palliat. 2008;7(4):229–233.
29.
RietjensJAvan der HeideAVrakkingAM. Physician reports of terminal sedation without hydration or nutrition for patients nearing death in the Netherlands. Ann Intern Med. 2004;141(3):178–185.
30.
Danel-BrunaudVLaurierLParentK. Les enjeux de la loi Leonetti: participation des patients atteints de sclérose latérale amyotrophique à une discussion anticipée sur la réanimation respiratoire et les soins de fin de vie. Rev Neurol (Paris). 2009;165(2):170–177.
31.
KeLSChiuTYLoSSHuWY. Knowledge, attitudes, and behavioral intentions of nurses toward providing artificial nutrition and hydration for terminal cancer patients in Taiwan. Cancer Nurs. 2008;31(1):67–76.
