The escalating number of foodborne diseases and food poisoning outbreaks demand a better call for improved food-handling practices. Hospices are typically described as nongovernmental organizations that offer palliative care to terminally ill patients. The majority of hospice food handlers are not trained in food safety aspects, and services are offered on a voluntary basis. In this study, a descriptive survey design comprising of semistructured questionnaire was utilized to assess the knowledge, attitudes, and practices of the hospice food handlers (n = 100) in hospices around Central South Africa. More than half of the participants (68%) had not taken basic food safety training. The average percentage of the correct answers on the knowledge questionnaire was 66.8%. The participants had a mean age of 35 years (SD = 9.27). Attendance of food safety course had a significant effect on both the practices of using gloves to touch or distribute unwrapped foods ( 2 = 8.411, p-value = .012), and washing hands after using gloves ( 2 = 12.560, p-value = .001). The overall KAP mean score was 78.38. A statistically significant difference was found between the trained and untrained food handlers regarding food safety knowledge (p < .001). There was substantial lack of knowledge regarding the correct temperature for a refrigerator including hot ready-to-eat food.
Voluntarily stopping eating and drinking is a means of hastening death. Unlike euthanasia or medical aid in dying, which are available only in certain jurisdictions and with assistance from health care
professionals, the ability to die by voluntarily stopping eating and drinking is determined by ongoing patient choice, although clinical and caregiver support is recommended. Few studies have examined the incidence of
patients choosing to stop eating and drinking; studies in the Netherlands and United States suggest patients hoosing this route have concerns about both physical and existential suffering. This article presents an
overview of voluntarily stopping eating and drinking, including guidance for clinicians, legal permissibility, and ethical discussions about whether the act constitutes suicide and how clinicians might respond to requests for information or support.
PURPOSE: Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because nutrition is traditionally considered a palliative treatment to be confined to the area of palliative cares, whereas the modern approach includes nutrition as an early supplemental support to improve compliance of patients with the oncologic therapies and total parenteral nutrition may be recommended in patients who would be destined to succumb prior from starvation-malnutrition than from tumour progression. Purpose of this paper if to define the potential as well as the limitations of nutritional interventions on both the survival and the quality of life of the advanced cancer patients.
RECENT FINDINGS: Some RCT on the use of oral, enteral and supplemental parenteral nutrition in patients on oncologic therapy show some benefit on compliance with therapy and in some domains of quality of life. Some malnourished (hypo)aphagic incurable cancer patients may survive longer thanks to parenteral nutrition, while few data suggest that quality of life may be maintained for a limited period of time. With a few exceptions, oncology and nutrition have till recently travelled on parallel tracks without talking each other. The oncologist who knows the natural history of the patients should understand which risk of complication and of poor tolerance to the treatment can malnourished patients carry and which is the potential of parenteral nutrition in hypophagic incurable patients.
Alonso was a 10-year-old boy with a recurrent, re-fractory brain tumor whose disease progressed through multiple therapies over many years. When no additional cancer-directed options remained, Alonso was admitted tothe hospital for symptom management as he approached the end of his life. Although Alonso was unresponsive and posturing, his family continued to hope desperately for a miracle. As they kept vigil around the bedside of his frail body, praying and waiting, they gradually began to notice—and then fixate on—how the sharp angle of his bones protruded more with each passing day.
Introduction: Health professionals in oncologic and palliative care settings are often faced with the problem that patients stop eating and drinking. While the causes of food refusal are very different, the result is often malnutrition, which is linked to health comorbidities and a high mortality rate. However, the professionals lack the time and knowledge to clarify the cause for each patient. What associations do health professionals have when faced with food refusal?
Objective: To investigate the associations that health professionals in oncological and palliative settings have about denied eating behavior
Methods: A cross-sectional study, starting with an open question focusing professionals’ associations regarding food refusal. The results were inductively analyzed, whereby generic categories were developed. Subsequently, the categories were transformed into quantitative data to calculate the relationships between the categories.
Results: A total of 350 out of 2000 participants completed the survey, resulting in a response rate of 17.5%. Food refusal is primarily associated with physical and ethical aspects and with end-of-life. Half of the participants frequently find that patients refuse to eat. The attitudes show that the autonomy of the patient is the highest good and is to be respected. Even in the case of patients with limited decision-making capacity, the refusal to eat is acceptable.
Conclusion: Clarifying the cause of food refusal requires a great deal of knowledge and is strongly influenced by the associations of health professionals. While the associations have very negative connotations, information and training is needed to make professionals aware of this and to change their associations. With this knowledge and in an interprofessional cooperation, mis-labelling of patient settings can be avoided and fears can be reduced.
Background: The nutrition profile of palliative home care clients is unknown. This study describes this group and their nutrition issues and evaluates the performance of the interRAI nutrition Clinical Assessment Protocol (CAP).
Methods: This was a cross-sectional secondary analysis using Ontario interRAI Palliative Care (interRAI PC) Assessment data. The sample represents 74,963 unique Ontario home care clients assessed between 2011 and 2018. Frequencies and standardized differences (stdiffs) of nutrition characteristics were presented for cancer (n = 62,394) and noncancer (n = 12,569) diagnostic subgroups. Rates of triggering the nutrition CAP were presented by nutrition issue to evaluate its performance.
Results: Of this sample, 16.7% were =85 years of age, 52.6% had a prognosis between 6 weeks and 6 months, and 41.4% required assistance with eating. The prevalence was higher among those with nervous/mental/behavioral disorders (72.6%) compared with those with cancer (37.6%; stdiff = 0.75). However, most nutrition issues experienced were similar (stdiff < 0.20) across diagnostic groups. Of the entire sample, 21% triggered the nutrition CAP, indicating a need for further evaluation or intervention. Yet, 73.4% of those who experienced dry mouth, 71.8% of those who required assistance with eating, and 68.4% of those who received a nutrition consult within the last 3 days did not trigger the nutrition CAP.
Conclusions: Nutrition issues are prevalent in palliative home care clients, regardless of diagnosis; yet the nutrition CAP identified a small fraction of this group. There is a need to focus research and care guidelines toward life-limiting illnesses beyond cancer and address nutrition-related issues in this population.
Objective: The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.
Method: This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2’-deoxyguanosine), and symptom intensity were evaluated.
Results: Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2’-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.
Conclusions: Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.
Increased attention is being paid to "dementia directives," advance directives tailored to persons with dementia that outline what treatments an individual with dementia might wish to receive or forgo should they lose capacity. Particular focus has been placed on the request to have assisted oral feedings withheld, the so-called Stopping of Eating and Drinking by Advance Directive (SED by AD), the purpose of which is to hasten death. This article reviews the available literature regarding the practice of SED by AD and explores the clinical and ethical aspects as they present at the bedside. Our review aims to show that practical, clinically applicable ways to approach such requests must be developed in order to balance the fundamental principles at play.
Background: The prediction of short-term survival is important for noncancer patients and their families. Although a markedly reduced oral intake by cancer patients suggests a poor prognosis, the survival times of noncancer patients after its onset remain unclear. We herein investigated the time from a marked reduction in oral intake to death in noncancer patients as well as factors associated with their subsequent survival.
Methods: We conducted a retrospective medical record review of noncancer patients who died in our hospital between April 2017 and April 2018. We recorded the day when oral intake markedly decreased and the date of death. We extracted data on age, gender, the Charlson Comorbidities Index, mean daily fluid volume, laboratory test results, and vital signs converted to the Shock Index (SI). We used Cox's proportional hazards models to assess relationships between these factors and survival times after the onset of a markedly reduced oral intake.
Results: We analyzed data from 44 noncancer patients. The median time from the onset of a markedly reduced oral intake to death was 16.5 days. Based on Cox's proportional hazards models, only SI >= 1.0 at the onset of a markedly reduced oral intake correlated with survival times (hazard ratio: 5.89, 95% confidence interval (CI): 1.71-20.1, P = .005).
Conclusion: Noncancer patients died a median of 16.5 days after the onset of a markedly reduced oral intake, and SI >=1.0 correlated with subsequent survival times. These results will provide novel insights into the prognosis of noncancer patients at the end of life.
Background: Nutritional impairment is common in cancer patients and adversely affects quality of life (QoL). The aim of this study was to investigate the association between nutritional status and QoL in incurable cancer patients in palliative care.
Methods: A prospective cohort with incurable cancer patients referred to the specialized Palliative Care Unit of the National Cancer Institute in Brazil was conducted. The nutritional risk (NR) was assessed using the Patient-Generated Subjective Global Assessment short form (PG-SGA SF), and cancer cachexia (CC) was defined according to the international consensus. QoL was evaluated using the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL). Multivariate linear regressions analyses were performed to assess the relationship between the nutritional status and QoL scores.
Results: A total of 1039 consecutive patients were included. A high prevalence of NR (85.4%) and CC (78.7%) were observed. The patients with worse nutritional status presented significantly poorer physical, emotional, symptoms domains scales, and overall QoL. CC were significantly associated with QoL scores for dyspnea (p = 0.013), insomnia (p = 0.046), and appetite loss (p = 0.015), while NR were associated with all the QoL domains scales covered in QLQ-C15-PAL.
Conclusion: Our findings support that impaired nutritional status was associated with poor QoL in incurable cancer patients. NR assessed by PG-SGA SF better reflects physical, emotional, symptom burden, and overall QoL scores. Thus, this tool may contribute in identifying patients at risk of deterioration QoL.
Pourquoi mange-t-on pour les morts, avec les morts ou, du moins, parmi eux ? Pourquoi l’être humain est-il allé jusqu’à manger ses morts et ceux des autres ? Comment ces rituels se déroulèrent-ils incessamment au fil des siècles et quel sens les participants entendirent-ils leur donner ? Ce ne sont là que quelques-unes des questions que nous avons tenté d’aborder à travers quelques exemples historiques.
Nous nous demanderons également ce qu’est vraiment un dernier repas et qui le mange et dans quelles conditions. En un mot, qui mange quoi et pourquoi. Nous évoquerons l’importance du banquet funéraire de l’Antiquité à l’Ancien Régime, et comment il aidait les populations à faire leur deuil et ressoudait les familles et les communautés.
Dans les temps contemporains, le banquet funéraire se résume, dans le meilleur des cas en une réception apéritive avec les plus proches parents ou les amis les plus intimes. Mais pendant des siècles, les funérailles ne pouvaient s’achever que par un repas, banquet funéraire ou ripailles villageoises. Nous demanderons donc également pourquoi une telle coutume a pu disparaître et quelle société avons-nous pour avoir fait disparaître une des coutumes les plus humaines qui aient été.
En Gaule, les rites funéraires comportent assez régulièrement des dépôts d’offrandes. Il s’agit principalement de vases, d’amphores, d’ossements animaux et de divers ustensiles en métal. Beaucoup de ces vestiges sont en rapport avec la consommation de boissons, vin ou cervoise, et de divers aliments, animaux ou végétaux. Cette présentation est plus particulièrement consacrée au partage des viandes entre défunt, bûcher et banquet funéraire, sachant que cette pratique est sans doute réservée à une élite.
Pouvez-vous expliquer pourquoi et comment vous organisez des apéritifs dans cette unité de soins palliatifs ? B.B. Ces apéritifs ont plusieurs modalités. Il se peut qu’en écoutant une personne malade ou sa famille, la question de l’alimentation, d’un plat ou d’un alcool, vienne sur le tapis, ou encore l’évocation d’un anniversaire, d’une fête ou d’un souvenir. Du coup, on peut émettre l’idée de boire ensemble, un apéritif par exemple. Le malade est extrêmement étonné de cette proposition, surtout venant d’un médecin. On appelle cela une petite fête ou un apéritif. Ça peut être du vin, du porto, rarement les alcools forts, tel que le whisky qui peut provoquer des irritations buccales. Ce peut être un blanc doux, un Sauternes. Du champagne ?B.B. Plus rarement le champagne. À ce moment-là, la personne hésite, ne sait pas trop, invoque le fait que son goût peut être modifié ou qu’elle ne peut plus avaler. Dans le cas où elle ne peut plus avaler, il est possible de mettre une goutte sur sa langue pour le goût. Ce petit projet est construit dans l’instantané, avec un proche s’il est présent, et avec deux ou trois membres de l’équipe qui sont disponibles et qui veulent bien venir. On s’interpelle entre nous et l’apéro est organisé vers midi et demi, en fin de visite. On demande aussi quelle musique le patient souhaite mettre. Ça peut se décider le matin pour le midi ou même sur le moment, car on ne sait pas si la personne sera vivante le lendemain. Il est aussi possible de partager un plat ou un alcool à n’importe quel moment, au goûter ou au soir…
Dans les Andes, les humains partagent nourritures et boissons avec leurs morts et scellent un pacte de réciprocité où les morts assureront pluies et bonne chance aux vivants tandis que ces derniers s’engageront à les alimenter. On se demandera d’abord pourquoi offrir des dons physiques à des entités dépourvues de corporéité puis ce qui incite défunts et vivants à se dévorer mutuellement pendant la période du retour des morts, à la Toussaint. On verra que ce cannibalisme symbolique permet un transfert d’énergie vitale entre morts et vivants.
Quelle place le repas de funérailles occupe-t-il dans les contes et coutumes de la Suisse romande ? L’article parcourt le monde des contes pour découvrir la relation que les vivants entretiennent avec les morts au travers des repas. Il traite de la place de l’os ainsi que d’autres symboles et fournit une analyse plus complète du conte du Petit Chaperon Rouge où la fillette mange sa grand-mère et accède au statut de femme. En conclusion, l’auteure interroge sa propre pratique du repas de funérailles dans le contexte d’une expérience personnelle de deuil.
Cet article présente une réflexion autour du repas funèbre et de tous les rites liant alimentation et mort en Corse. Nous effectuerons un tour d’horizon à partir des traces les plus anciennes évoquant le sacrifice et la consommation de chair animale près des sépultures, d’anciennes dispositions testamentaires pour des honneurs alimentaires post mortem, jusqu’à l’époque actuelle marquée par l’évolution des rituels liant mort et nourriture. Nous verrons ainsi que tout ce qui fait le lien entre nourriture symbolique et rituel funéraire témoigne d’une véritable idéologie de la mort se situant sur un continuum culturel.
À la Toussaint, les populations amérindiennes du Mexique déposent des aliments et des boissons sur les tombes et les autels dressés dans les maisons, afin d’apporter un réconfort aux morts réputés être engagés dans un épuisant cheminement post-mortem. Quel sens attribuer à cette « vitalité » post-mortem ? Comment expliquer que des êtres, que l’on ne peut percevoir, puissent se mouvoir et consommer des aliments ? En s’appuyant sur les résultats d’une enquête ethnographique réalisée chez les Mixe de l’État de Oaxaca, cet article apporte des éléments de réponses à cette interrogation. En même temps que la mise au jour des conceptions relatives aux mécanismes physiologiques à l’œuvre chez les morts, l’enjeu est de déterminer quelles relations sociales les vivants établissent par l’intermédiaire de la nourriture et des boissons avec ces êtres au statut ambivalent à qui les familles doivent rendre hommage tout en maintenant une certaine distance.
Advanced cancer patients with cachexia and their families can suffer from eating-related distress. This complex entity encompasses patients’ struggle to nourish themselves, emotional and social consequences of their inability to maintain food intake, and profound disturbance in family relationships. With evidence-based nutritional care, as well as symptom management to enable food intake, cachexia can be mitigated to some degree. In addition, patients and families require psychosocial support and education to understand and cope with this condition. Only by taking an integrated approach can health care teams alleviate eating-related distress, improve quality of life (QOL), reduce interpersonal conflicts, and alter perceptions of nutritional neglect for patients and families. However, few studies have investigated eating-related distress among patients and families. The aim of this narrative review is to describe what is known about eating-related distress and the roles of integrated palliative, supportive, and nutritional care in improving QOL of patients and families.
OBJECTIVE: The objective of this paper is to explore the ethical and legal validity of advance directives that request the voluntary stopping of eating and drinking against a backdrop of late-stage dementia.
METHOD: Doctrinal research and analysis of primary and secondary materials including Australian legislation, Australian case law and journal articles was undertaken.
RESULTS: There is legal uncertainty in Australia around whether an advance directive to voluntarily stop eating and drinking will be followed should the adult become incompetent.
CONCLUSION: Voluntary stopping of eating and drinking should be viewed in law as a form of "treatment" that competent adults can nominate in advance directives, thereby providing dementia patients with the opportunity to choose in advance, if they wish, to end their life legally, with dignity and comfort, and in a manner that does not implicate others in criminal behaviour such as assisted suicide, acceleration of death or euthanasia.