Short CommunicationTipping point: When patients stop eating and drinking in the last phase of their life
Section snippets
Background
Eating and drinking are preconditions for survival and essential elements of cultural and social life. Shared meals are connecting families and social groups.
Malnutrition is common in cancer disease and in treating cancer nutritional support is often needed. Patients are often reminded by families and health care professionals to eat and drink enough and if the patients are unable to do so, artificial nutrition is prescribed [1].
In end of life care, appetite and thirst diminish and it
Methods
This retrospective analysis was performed on a specialist palliative care ward (sPCW) of a tertiary comprehensive cancer center. All deceased patients, oncological or non-oncological, hospitalized on this ward between January 2015 and September 2017 were included. Patients that were discharged were excluded.
Demographic and medical data as well as the specific nutrition and hydration module in the daily nursing assessment system (ePA-AC©, result oriented nurse assessment for acute care) were
Results
From 2015 to 2017, 1194 patients were treated on the specialist palliative care ward.
A total of 683 patients (57%) died on the ward and were included for tipping point analysis. Median length of stay was 17 days for the deceased.
Characteristics of the included patients are displayed in Table 2.
A “tipping-point-solid” was identified in 291 of these 683 patients (43%) with a mean of 7.8 days (SD 7.6; CI 7.5–6.2) with a median of six days from tipping-point-solid to death.
A tipping-point-fluid was
Discussion
In the present report, a definitive tipping point solid/fluid could be detected in less than half of dying patients. In these patients, the tipping-point-solid lay within two weeks and the tipping-point-fluid within few days before death.
In recent years voluntarily stopping eating and drinking is an intensely debated way to hasten death and median time to death lays at around 7 days as reported by nurses and physicians in two surveys [6,7]. However, if patients still take little fluids survival
Conclusion
In less than half of dying patients a definitive tipping point, solid/fluid could be detected. Tipping-point-solid lay within two weeks and tipping-point-fluid within few days before death. No specific characteristics for patients displaying a tipping point could be detected. This underlines dying as an individual process and explains daily challenges in detecting the best time to change care strategy.
Funding and Acknowledgments
This study has been conducted without grants or funding.
David Blum and Karin Oechsle are responsible for design study, practical performance, data analysis, and preparation of the manuscript, all others were involved in the critical review of the manuscript, and none of the authors has a conflict of interest concerning this study.
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