Agreements and disagreements on indication and continuity of enteral nutritional therapy in palliative care patients with non-communicable diseases

Abstract

Non-communicable diseases (NCD) are the leading cause of hospital admissions, result in socioeconomic impacts and prejudice on quality of life due to after-effects and disabilities, justifying the importance and the increasing need to associate palliative care with curative treatment. This narrative review aims to introduce agreements and disagreements on indication and continuity concerning enteral nutritional therapy (ENT) in palliative care patients with NCD. This paper was based on official publications related to the topic and 15 articles found on LILACS, SciELO, PubMed, MEDLINE, Cochrane Library and Science Direct databases, between the years 2005 and 2016. In these patients, the objective of nutritional support in palliative care varies according to the evolution of the disease. Oral nutritional supplement is indicated to supplement insufficient oral food intake, reducing hospital costs and favoring clinical and functional improvements. When food intake is less than 60% and without evolution prospects, ENT is indicated within the first 3 days, but withholding and withdrawing it in advanced diseases remains controversial. In terminal phase, comfort and relief of symptoms are the priority instead of nutritional adequacy. On this stage, artificial nutrition and hydration may not be beneficial. Therefore, nutrition in palliative care is individualized, depends on the stage of the disease and aims to promote life quality. Decisions must be taken considering patient and relatives’ will, principles of autonomy, beneficence, no maleficence and justice.