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FEEDING THE TERMINALLY ILL: HOW MUCH IS NEEDED?

Discussions about improving terminal care have generally focused on resuscitation and therapeutic interventions, with less attention to the appropriate use of nutrition and fluids. These researchers evaluated the frequency of thirst and hunger in 32 patients admitted to a comfort care unit in a long-term care facility.

Nearly all the patients had cancer and a life expectancy of three months or less. All were mentally aware and competent. Patients were offered whatever food they felt they could eat but were not "force-fed." All received careful oral care including ice chips, hard candy, and lubricants.

Sixty-three percent of the patients never felt hunger, and 34 percent had hunger only at the beginning of their stay in the comfort care unit. Similarly, 62 percent of patients either had no thirst or had thirst only initially. All patients died; during their stay, 84 percent were considered to have had no discomfort, and none had discomfort that could not be relieved. Only small amounts of food, liquid, and oral care were generally needed to relieve thirst and hunger.

Comment: These data call into question the practice of emphasizing adequate nutrition for terminally ill patients. Giving nutrition and hydration beyond that desired by the patient does not seem necessary for a comfortable death.

— TH Lee

Published in Journal Watch General Medicine November 8, 1994

Citation(s):

McCann RM et al. Comfort care for terminally ill patients: the appropriate use of nutrition and hydration. JAMA 1994 Oct 26 272 1263-1266.

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