title: Caregivers Confronted With the Withdrawal of Artificial Nutrition at the End of Life: Prevalence of and Reasons for Experienced Difficulties.
abstract: BACKGROUND
  Withdrawing artificial nutrition in palliative care is an issue that often leads to ethical dilemmas among health care providers, despite clinical guidelines.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Palliative Care Department, Metz-Thionville Regional Hospital, Hayange, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Piot
authors.affiliation: Palliative Care Department, Metz-Thionville Regional Hospital, Hayange, France b.leheup@chr-metz-thionville.fr.
authors.forename: Benoît F
authors.initials: BF
authors.lastname: Leheup
authors.affiliation: Clinical Research Support Unit, Metz-Thionville Regional Hospital, Metz, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Goetz
authors.affiliation: Nutrition department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Quilliot
authors.affiliation: Geriatric department, Nancy University Hospital, Vandoeuvre-lès-Nancy, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Niemier
authors.affiliation: Palliative Care Department, Bernard Wary, Metz-Thionville Regional Hospital, Metz, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Wary
authors.affiliation: Department of Neurology, Nancy University Hospital, Nancy, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Ducrocq
mesh_terms: D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009014:Morals; D018529:Nutritional Support / Q000941:ethics / Q000523:psychology*; D010348:Patient Care Team / Q000941:ethics; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology*
keywords: artificial nutrition; ethics; healthcare provider’s burden; palliative care