title: Palliative care professionals' perceptions of nutrition and hydration at the end of life.
abstract: The provision of medically administered nutrition and hydration (MNH) for the terminally ill patient is a controversial issue and there has been much debate in the literature concerning this sensitive subject. This article reports on a qualitative research study that explores palliative care nurses' and doctors' perceptions and attitudes to patient nutrition and hydration at the end of life. Participants were from an urban and rural palliative care service. Three main discourses were identified: carers' distress at the non-provision of MNH; palliative care doctors' and nurses' position that terminal dehydration lessened the burden of suffering for dying patients; and polarisation between the acute care setting and the palliative care setting. Overlaying these three main discourses are contesting discourses involving cure vs comfort, and acute care vs palliative care. Importantly, the findings of this study reveal that palliative doctors and nurses believe that medically assisted nutrition and hydration at the end stage of life rarely benefits patients, and as long as adequate mouth care is given, patients do not suffer. However, family members do experience emotional distress in dealing with this situation. In caring for dying people, the nurse's and doctor's role is one of education and communication, involving a team approach to manage this difficult issue.
authors.affiliation: School of Nursing and Midwifery, University of Newcastle, Australia. Pamela.vanderriet@newcastle.edu.au
authors.forename: Pamela
authors.initials: P
authors.lastname: van der Riet
authors.forename: Philip
authors.initials: P
authors.lastname: Good
authors.forename: Isabel
authors.initials: I
authors.lastname: Higgins
authors.forename: Ludmilla
authors.initials: L
authors.lastname: Sneesby
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003681:Dehydration / Q000517:prevention & control / Q000523:psychology; D004645:Empathy; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D019317:Evidence-Based Medicine; D005190:Family / Q000523:psychology; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000523:psychology; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D008505:Medical Staff, Hospital / Q000523:psychology*; D009013:Morale; D009517:New South Wales; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000523:psychology*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010344:Patient Advocacy; D036301:Qualitative Research; D013315:Stress, Psychological / Q000517:prevention & control / Q000523:psychology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome