Am J Hosp Palliat Care. 2014 Jun 13. pii: 1049909114539037. [Epub ahead of print]

Caregivers Confronted With the Withdrawal of Artificial Nutrition at the End of Life: Prevalence of and Reasons for Experienced Difficulties.

Piot E1, Leheup BF2, Goetz C3, Quilliot D4, Niemier JY5, Wary B6, Ducrocq X7.

Author information

• 1Palliative Care Department, Metz-Thionville Regional Hospital, Hayange, France.
• 2Palliative Care Department, Metz-Thionville Regional Hospital, Hayange, France b.leheup@chr-metz-thionville.fr.
• 3Clinical Research Support Unit, Metz-Thionville Regional Hospital, Metz, France.
• 4Nutrition department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
• 5Geriatric department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
• 6Palliative Care Department, Bernard Wary, Metz-Thionville Regional Hospital, Metz, France.
• 7Department of Neurology, Nancy University Hospital, Nancy, France.

Abstract

BACKGROUND:

Withdrawing artificial nutrition in palliative care is an issue that often leads to ethical dilemmas among health care providers, despite clinical guidelines.

OBJECTIVES:

To describe the experience of health care providers confronted with the withdrawing of artificial nutrition at the end of life and identifying the factors related to the level of ethical dilemmas.

METHODS:

Cross-sectional survey questionnaire of all the nurses and nurses' aides working in medicine, surgery, and palliative care departments of a regional hospital and who have already been confronted with the withdrawal of artificial nutrition.

RESULTS:

Of 818 questionnaires sent, 274 were returned (response rate 33.5%); 60% (163) of the care providers who responded were involved in withdrawing artificial nutrition at the end of life. Among these, 42 (25.8%) had always or often been affected with ethical dilemmas, and 97 (60%) responded that withdrawing artificial nutrition had always or often been preceded by a multidisciplinary discussion. Items significantly associated with a high level of ethical dilemmas were (1) existence of differences in opinion within the health care team, (2) lack of information regarding the indication of the withdrawal of artificial nutrition, (3) feeling uncomfortable with the patient and his or her relatives, (4) guilt, (5) feeling of abandonment of care, and (6) uneasiness.

CONCLUSION:

Health care providers seem to have a lack of information and consensus regarding the withdrawal of artificial nutrition at the end of life. The ethical dimension of withdrawing artificial nutrition in palliative care has a strong impact on care providers, regardless of the circumstances of the withdrawal.