title: Declining oral intake towards the end of life: how to talk about it? A qualitative study.
abstract: BACKGROUND
  Decreasing oral intake is common towards the end of life and a potential source of distress and concern for patients, relatives, whānau and clinicians. This paper provides insight to inform practice regarding clinicians' perceptions, practices, responses and communication with patients and their companions regarding declining oral intake towards the end of life.
  
  
  METHODS
  In this qualitative study ten specialist palliative care staff participated in semi-structured interviews. Qualitative thematic analysis was used to analyse the data.
  
  
  RESULTS
  Three themes were identified: declining oral intake was a natural part of the dying process; responding empathetically; and clinicians described specific aims and ways regarding communication.
  
  
  CONCLUSIONS
  Insight into clinicians' endeavours to manage declining oral intake and support the wellbeing of patients, families, and whānau can inform practice. However the perspectives of family, whānau and health professionals continue to show significant variation regarding the communication given and received around declining oral intake towards the end of life.
authors.affiliation: Clinical Nurse Specialist, Arohanui Hospice Palmerston, North New Zealand.
authors.forename: Jean
authors.initials: J
authors.lastname: Clark
authors.affiliation: Post Doctoral Researcher, Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands.
authors.forename: Natasja J H
authors.initials: NJ
authors.lastname: Raijmakers
authors.affiliation: Director of Palliative Care, Arohanui Hospice and Palliative Medicine Specialist, Palmerston North Hospital, New Zealand.
authors.forename: Simon
authors.initials: S
authors.lastname: Allan
authors.affiliation: Medical Oncologist, Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, Netherlands.
authors.forename: Lia van
authors.initials: LV
authors.lastname: Zuylen
authors.affiliation: Professor in end-of-life care and decision making, Erasmus MC Department of Public Health, Rotterdam, Netherlands.
authors.forename: Agnes van der
authors.initials: AV
authors.lastname: Heide
mesh_terms: D003142:Communication; D004327:Drinking Behavior; D004645:Empathy; D005190:Family; D005247:Feeding Behavior; D005260:Female; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D009726:Nurses; D065126:Palliative Medicine; D010820:Physicians; D036301:Qualitative Research; D013727:Terminal Care
keywords: Communication; Community nursing; Food and fluids; Interdisciplinary working