Nutrition and Hydration in Dying Patients: Annotated Bibliography

This annotated bibliography examines the crucial role of nutrition and hydration in the care of dying patients within acute care settings. It analyzes four key publications, including research studies and literature reviews, to provide a comprehensive understanding of the topic. The bibliography begins with Akbulut's work on nutritional support for cancer patients, exploring the benefits of enteral and parenteral nutrition. Higgins et al. investigate nurses' perceptions of nutrition and hydration in end-of-life care, emphasizing the importance of a palliative approach. Hui, Dev, and Bruera discuss the impact of nutrition and hydration on symptom burden during the last days of life, particularly for cancer patients, and Raijmakers et al. review the practices and effects of artificial nutrition and hydration in the final week of life. Each entry includes a complete reference, a summary of the main points and conclusions, and a critical evaluation of the article's methodology, author's position, and relevance to nursing practice. The bibliography highlights the ethical dilemmas and practical considerations faced by healthcare professionals in providing appropriate and compassionate care for terminally ill patients, emphasizing the importance of balancing the benefits and risks of artificial interventions and prioritizing patient comfort and quality of life.

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Annotated Bibliography: Nutrition and Hydration in Dying Patients in Acute Care Settings
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Akbulut, G. (2011). New Perspective for Nutritional Support of Cancer Patients:
Enteral/Parenteral Nutrition. Experimental and Therapeutic Medicine, 675-684.
doi:10.3892/etm.2011.247
The article by Akbulut focuses on new concepts on nutritional support for dying patients,
having cancer. The author has discussed the treatment for patients with terminal cancer and the
effects associated with those treatments. The article describes the term ‘quality of life' which
deteriorates due to the biochemical and physiological alterations that are associated with cancer
treatment. The study found that cancer cachexia and other complications can arise due to cancer-
related malnutrition as complex interactions can take place between the host metabolism and
pro-inflammatory cytokines. In addition to this, the study highlighted that nutritional support for
dying patients is often supported for several illnesses, including medical oncotherapy and
surgery. The medical monotherapy in this case also covers the radiation therapies and
chemotherapies for cancer. Enteral and parenteral nutrition has been found to be helpful and to
be associated with improved condition among patients. Specifically, the said nutrition has been
to boost the quality of life, functional status, and patient survival, in a positive way.
The methodology of the study is based on reviewing data taken from the previous
research on the subject. To conduct the research, the author has collected peer-reviewed journal
articles and other research studies that are based on patients that have terminal diseases and are
near to death.
The findings of the study have revealed that parenteral and enteral nutrition support can
considerably lower the catabolic rate among patients which can help them to withstand the
effects of therapeutic measures in a better way. Those terminally ill cancer patients require
palliative care who are refractory to different therapeutic measures. In addition to this, the author

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of this study views nutrition as a basic human right and therefore perceives it vital for the
survival of a patient in an acute care setting. However, the study has found that there are still
some patients who are suffering from such specific conditions such as intestinal problems which
make the route of nutrition impossible. In such patient groups, instead of using enteral nutrition,
palliative parenteral nutrition should be used. Moreover, the decision of choosing the route of
nutrition must be taken after performing a multidisciplinary analysis of the patient’s condition.
More importantly, the patient, as well as the caregivers, must take it in account that at terminal
stages, the treatment will not prolong the patient's life.

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Higgins, I., Riet, P. v., Sneesby, L., & Good, P. (2014). Nutrition and Hydration In Dying
Patients: The Perceptions of Acute Care Nurses. Journal of Clinical Nursing, 2609-
2617. Retrieved from ncbi.nlm.nih.gov/pubmed/24354446
The study by Higgins, Riet, Sneesby, and Good is aimed to explore how nurses and
caregivers perceive medical nutrition and hydration that is given to a terminally-ill patient in an
acute care setting. Whenever people are near to their death, due to medical conditions, they have
a serious absence of appetite and thirst, which are important natural and biological processes for
the functioning of the body. Therefore, this study uses data from previous studies to look into the
methods and perceptions of providing nutrition and hydration to dying patients in an acute care
setting.
The study has been based on a qualitative descriptive design and establishes itself on the
findings of previous studies in this domain. More importantly, the methodology of this study has
been based on focus group meetings. The authors arranged focus group meetings with ten nurses,
who have worked with terminally ill patients in an acute care setting. The nurses were chosen
from the departments of hematology, oncology, and medical units. All the participants of this
interview groups were asked questions, which were based on an interview schedule. Also, the
same schedule was used to drive the discussions during the focus groups. For data analysis, a
thematic design was used. All the transcripts recorded during interview groups were read several
times, and important points were highlighted, clustered, and coded by using themed headings.
The study found that a palliative approach is positively effective for dying patients who
are in acute care settings because the said approach can properly mediate the focus on effective
care of patients. Furthermore, the study found that the caregivers in acute settings should be able
to mandate this approach so that decision-making during the end of life care can be strengthened.

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In addition to this, the study found that artificial hydration and nutrition of a patient during their
last days can effectively improve the condition of patients who are going through chemotherapy,
curative radiotherapy, and other similar treatments which are used on terminally-ill patients. For
the validation of the previous literature and hypotheses, the study uses data from the interviews
which were collected during focus groups with the nurses who had practical experience on the
subject.

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Hui, D., Dev, R., & Bruera, E. (2015). The Last Days of Life: Symptom Burden and Impact
on Nutrition and Hydration in Cancer Patients. Current Opinion in Supportive and
Palliative Care, 346-354. Retrieved from
ncbi.nlm.nih.gov/pmc/articles/PMC4792116/
In their study, Hui, Dev, and Bruera review the impacts of nutrition and hydration on
dying patients during their last days. Also, the study examines the role of nutrition and hydration
in extending life expectancy among dying patients. Specifically, the study has focused on
patients who have terminal cancer. Whenever people are terminally ill, they have a serious lack
of appetite and thirst, which are important natural and biological processes for the functioning of
the body. Therefore, this study uses data from previous studies to look into the methods and
impacts of providing nutrition and hydration to dying patients who have terminal cancer. The
study described the loss of functionalities among patients during their last days when symptom
burden gets worsened. A number of symptoms such as delirium, dysphagia, and anorexia-
cachexia can seriously hinder oral intake of patients. This can contribute to reduced quality of
life, loss in weight, and other diseases due to weaknesses. Furthermore, the inability to eat or
drink can lead to emotional distress for caregivers and patients. Therefore, the nutrition and
hydration of patients are ensured through artificial methods.
The methodology of the study is based on a descriptive and literature analysis approach.
For the conduction of this study, the authors have collected all the relevant literature on the
subject and have effectively used it to analyze the impact of nutrition and hydration among dying
patients.
The study found that artificial nutrition is not recommended for terminally-ill patients during
their last days, in an acute care setting. The reason for this is artificial nutrition has been found to

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be associated with several harmful effects. However, the option of providing artificial nutrition
should be considered in terms of benefits and risks. For this purpose, the caregivers must
critically analyze the condition of the patient. As for artificial hydration, there are no general
adverse effects, and it offers some benefits due to which it is recommended to be used among
terminally-ill patients. In addition to this, the study suggests that caregivers must try to take
active measures to treat any possible impact that might result due to an intake of nutrition. The
risk of complications must be balanced with maximizing the comfort of patients if they desire to
eat or drink something orally.

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Raijmakers, N. J., Zuylen, L. v., Costantini, M., Caraceni, A., Clark, J., Lundquist, G., . . .
Heide, A. V. (2011). Artificial Nutrition and Hydration in the Last Week of Life in
Cancer Patients. A Systematic Literature Review of Practices and Effects. Annals of
Oncology, 1478–1486. doi:10.1093/annonc/mdq620
The study describes the benefits and risks associated with hydration and nutrition of
dying patients in an acute care setting. People, who are terminally ill, do not eat or drink
normally as other people do. The lack of thirst and appetite has adverse effects on the proper
functioning of the body. During the last days of terminally-ill cancer, several symptoms or
problems are developed in the biological system of a patient which can seriously hinder oral
intake of patients. This can cause the quality of life to reduce. Also, weight loss is observed
along with other diseases due to physical weaknesses. Furthermore, the inability to eat or drink
can lead to emotional distress for caregivers and patients. Therefore, the nutrition and hydration
of patients are ensured through artificial techniques. Therefore, this study uses data from
previous studies to look into the methods and impacts of providing nutrition and hydration to
dying patients who have cancer.
For the conduction of this research, papers were searched systemically in PubMed,
EMBASE, PsychInfo, and CINAHL. All the chosen research studies were in English and
published between January 1998 and July 2009. More importantly, all those studies were
selected in the said timeline that contained information on the effects of artificial hydration and
artificial nutrition in cancer patients during their last days.
The study found that it was a common practice to provide artificial nutrition and artificial
hydration to terminally ill cancer patients during their last days. However, the study found that
there were limited benefits of artificial hydration and nutrition on cancer patients, in terms of

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length of survival, comfort, and symptoms. Also, the study found that some of the reviewed
studies had revealed the positive effects of artificial hydration. The positive effects include lesser
physical dehydration signs and lesser chronic nausea. However, there were negative effects as
well, which included increased intestinal drainage and more ascites. In addition to this, it was
also found that there were no effects on fluid overload and terminal delirium. However, the study
failed to provide any effect of artificial nutrition on cancer patients during their last days. The
study also found that professional caregivers in acute care settings were reserved about the
possible benefits of artificial nutrition and artificial hydration as most of them do not believe that
any of artificial hydration or nutrition were associated with relieving symptom burden.

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References
Akbulut, G. (2011). New Perspective for Nutritional Support of Cancer Patients:
Enteral/Parenteral Nutrition. Experimental and Therapeutic Medicine, 675-684.
doi:10.3892/etm.2011.247
Higgins, I., Riet, P. v., Sneesby, L., & Good, P. (2014). Nutrition and Hydration In Dying
Patients: The Perceptions of Acute Care Nurses. Journal of Clinical Nursing, 2609-2617.
Retrieved from ncbi.nlm.nih.gov/pubmed/24354446
Hui, D., Dev, R., & Bruera, E. (2015). The Last Days of Life: Symptom Burden and Impact on
Nutrition and Hydration in Cancer Patients. Current Opinion in Supportive and Palliative
Care, 346-354. Retrieved from ncbi.nlm.nih.gov/pmc/articles/PMC4792116/
Raijmakers, N. J., Zuylen, L. v., Costantini, M., Caraceni, A., Clark, J., Lundquist, G., . . . Heide,
A. V. (2011). Artificial Nutrition and Hydration in the Last Week of Life in Cancer
Patients. A Systematic Literature Review of Practices and Effects. Annals of Oncology,
1478–1486. doi:10.1093/annonc/mdq620