Artificial Enteral Nutrition versus Oral Nutrition as Related to Outcomes in Palliative Care Patients with Dysphagia

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Artificial nutrition may supplement or replace oral feeding at the end of life, but it is unclear if this is the best option for nutrition and quality of life. Tube feeding (nasogastric/gastric) is assumed to reduce patient harm from malnutrition. Nutritional counseling may favor tube feeding due to feared consequences of aspiration. Clinicians are questioning these practices as studies reveal associations between tube feeding and increased morbidity and mortality. The aim of this research was to study the association of feeding method (tube versus oral) to pneumonia, depression, and death in patients with life-limiting illness and dysphagia. The researcher analyzed 2,180 records of patients admitted to a tertiary center between January 1, 2014 and September 30, 2017 and treated by Palliative Medicine. Patient outcomes (pneumonia, depression, death), feeding route, presence or absence of dysphagia (diagnostic criteria unknown), and covariates (chronic obstructive pulmonary disease, stroke, mortality risk, illness severity, sex, age) were collected via electronic chart audit. Of 292 patients who met the inclusion criteria, 188 were matched using propensity score analysis. The odds of pneumonia increased 10.14 times with tube feeding (p < .001). Probability of pneumonia was 91% (P = .910), compared to a 9% chance with oral feeding (OR = 0.099, P = .090). The odds of depression increased 2.79 times with tube feeding (p = .01). Probability of depression was 73.6% (P = .736), compared to a 26.4% chance with oral feeding (OR = 0.358, P = .264). The odds of death increased 3.02 times with tube feeding (p < .01). Probability of death was 75.1% (P = .751), compared to a 24.9% chance with oral feeding (OR = 0.331, P = .249). Results indicate a greater probability that pneumonia, depression, or death occurs with tube feeding (vs oral) for terminally-ill patients who are diagnosed with dysphagia and stroke or chronic obstructive pulmonary disease.

Palliative care, Dysphagia, Tube feeding, Swallowing, Oral Feeding, Ethics