Nutrition at the End of Life: It’s Not What You Say, It’s How You Say It

Abstract

The purpose of this review is to describe and appraise the available scientific evidence to guide the use of artificial nutrition and hydration at the end of life, with a focus on communicating with patients and families who are facing these decisions. Research suggests artificial nutrition and hydration (ANH) may be burdensome at the end of life, yet disparities for its use in clinical practice persist. While no clear evidence supports the use of ANH for the majority of terminally ill patients, emerging data suggests that a subset of patients may derive some benefit. No clear criteria exist to ascertain the beginning of the dying phase, which can present challenges surrounding ANH. A better understanding of symptom burden and thoughtful communication between the clinician and patient can facilitate development of a medical plan of care, with or without ANH, that best meets the patient’s goals of care.