title: Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff.
abstract: BACKGROUND
  Decrease in oral intake, weight loss, and muscular weakness in the last phases of a terminal illness, particularly in the context of the cachexia-anorexia syndrome, can be an important source of anxiety for the triad of patient, family, and health staff.
  
  
  METHODS
  The present literature review examines the emotional impact of reduced oral intake as well as perceptions and attitudes toward assisted nutrition and hydration for terminally ill patients(1)  at the end of life, among patients, family, and health care staff. We have identified the ways in which emotional and cultural factors influence decision-making about assisted nutrition and hydration.
  
  
  RESULTS
  Lack of information and misperceptions of medically assisted nutrition and hydration can play a predominant role in the decision to begin or suspend nutritional or hydration support.
  
  
  CONCLUSIONS
  Our literature review reveals that these social, emotional, and clinical misperception elements should be considered in the decision-making processes to help the triad develop functional forms of care at this final stage of life. Copyright © 2011 John Wiley & Sons, Ltd.
authors.affiliation: Programa de Medicina Paliativa y Cuidados Continuos, Departamento de Medicina Interna, Pontificia Universidad Católica de Chile, Santiago, Chile. delrio.ini@gmail.com
authors.forename: M I
authors.initials: MI
authors.lastname: Del Río
authors.forename: B
authors.initials: B
authors.lastname: Shand
authors.forename: P
authors.initials: P
authors.lastname: Bonati
authors.forename: A
authors.initials: A
authors.lastname: Palma
authors.forename: A
authors.initials: A
authors.lastname: Maldonado
authors.forename: P
authors.initials: P
authors.lastname: Taboada
authors.forename: F
authors.initials: F
authors.lastname: Nervi
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003657:Decision Making; D004644:Emotions; D005190:Family / Q000523:psychology; D005440:Fluid Therapy; D006801:Humans; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*; D009752:Nutritional Status; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D010358:Patient Participation; D010465:Perception; D013727:Terminal Care / Q000523:psychology*