Regardless of academic evidences, most of patients and their family had resistance in withholding parenteral nutrition (PN) when the patient became unable to intake food in the end of life. We investigated whether the preference for PN is changes after an individual education and find out the reason of their choice.
Patients are eligible if aged ≥20 years, cannot tolerate enteral feeding, have Palliative Performance Scale ≤ 50% due to progressive cancer. Patients with functioning bowels were excluded. If patient sign consent, a trained nurse educated patients and family for about an hour using the printed materials. After education, patients made decision whether to receive or not to receive PN. An anthropologist combined in-depth interview of patients and family to look into their concerns and reason of the choice. Quality of life was and severity of symptoms related to fluid overloading or dehydration was surveyed also.
Total 18 patients participated in this study. At the consent, 15 patients (group A, 83.3%) are receiving PN and 3 patients (group B) are receiving less than 1 liter of 5% dextrose water. After education, 12 patients (group A1, 80%) chose to keep receiving PN and 3 patients (group A2, 20%) changed their decision from PN to minimal hydration among the group A. All of the group B patients did not want to receive PN. Nine patients (75%) among the group A1 recognized that they are in terminal state. In group A2, all 3 patients had complete insight about their disease stage and prognosis. Median survival time and quality of life did not differ according to PN administration. In the interview, medical staffs regard PN as a complex medical treatment, patients and family recognize it as meal rather than medicine. Hence, most of families want to administer PN though it aggravates patients' symptom because they think that it is humane duty to nurture their loved ones until death.
Most terminal cancer patients and their family chose to receive PN irrespective of its risk and benefit. Clear insight into disease prognosis and understanding about the meaning of palliative care must precede the decision whether to receive PN.
Clinical trial identification
All authors have declared no conflicts of interest.