Dietitians Role in Palliative Care

Palliative Care
Comfort Care
In a patient with a serious illness, an
For patients who no longer have curative treatments
interdisciplinary team (IDT) works
available to them, and the goals of care have moved toward
with the patient and patients family
symptom management and patient comfort.
to provide relief from symptoms and
Comfort care may be provided before one is eligible to
stress of the illness. The goal is to
receive hospice care.
improve quality of life for both patient GIP (General Inpatient) Comfort Care
and the patients family.
Intended to be a short-term intervention; if, the patients
It is appropriate at any age and at
symptoms cannot be effectively managed at home, then the
any stage in a serious illness. Can be
patient is eligible for more medically intense level of care in
provided along with curative
a setting outside the home (often a hospice unit, SNF or
treatment.
hospital).
Focuses on symptoms such as pain,
SOB, fatigue, constipation, nausea, Hospice
loss of appetite, difficulty sleeping
Hospice focuses on caring, not curing and, in most cases,
and depression.
care is provided in the patients home.
Helps patient gain strength to carry
Can only be offered at the point ones life expectancy is
on with daily life. Helps patient gain
anticipated to be six months or less and when curative
control over their care by improving
treatments are no longer being pursued.
understanding of their treatment
choices.

Nutrition Goals for Palliative Care:

1. Cope with metabolic demands of illness and
treatment
2. Maintain immunocompetence and reduce the
risk of infection
3. Promote wound healing and repair tissue
damage
4. Promote overall wellbeing and quality of life
When to use nutrition support:
Disease related
malnutrition
Weight loss
Reduced appetite and
early satiety
Swallow difficulties
Also depends on stage of
disease
o Curative phase
always
appropriate
o Palliative phaseusually
appropriate
o Terminal phase
rarely

RD should:
Assess nutritional needs and problems
Establish which nutritional support measures are
appropriate
Use of appropriate supplements
Enteral and parenteral nutrition support
Provide advice on:
o Poor appetite, sore or dry mouth, taste
changes, early satiety, GI symptoms

Oral Nutrition Support

if a patient can eat,
encourage PO!
High energy and
high protein
Food Fortification
Appetite
stimulation
Provide oral supplements
if a patient cannot
consume enough to
prevent wasting
High energy and
high protein
drinks
Puddings
Powders

Enteral Nutrition
NG, NJ, PEG
Recommendations based on estimated needs
Depending on living situation, may require
education.
When:
Incapable of PO
Persistent swallowing difficulties
Parenteral Nutrition
Used when GI tract is not functional
Consider risks vs. benefits
In a patients last few days:
Food and fluids for pleasure and comfort;
not for survival
Nutrition support not usually
appropriate
Artificial hydration is controversial

References Used:
National Hospice and Palliative Care Organization (NHPCO.org); Getpalliativecare.org;
http://www.espen.org/presfile/Palliative-KentSmith.pdf; Center for Advance Palliative
Care (capc.org); American Academy of Hospice and Palliative Medicine (aahpm.org)