Authors (including presenting author) :
AU LFV(1); LUI PSG(1); SAM HYC(1); TAM KO (1); SHUM PSE(2); CHUI WST (2);LO WKS (3) ; LO RSK (2)
Affiliation :
(1) Department of Dietetics (2) Department of Hospice and Palliative Care, Bradbury Hospice and Shatin Hospital (3) NTEC Cluster Dietetic Service
Introduction :
Palliative patients often experience cachexia and anxiety related to loss of appetite, which can significantly affect their quality of life (QoL). With the goal to improve the palliative nutrition care model at Bradbury Hospice and Shatin Hospital, a patient-centered care guideline was developed and implemented in October 2016. This pilot study was carried out in Q3 2018 to evaluate the effectiveness of the new patient-centered care guideline on patient’s prospective changes in nutrition-related clinical outcomes.
Objectives :
To evaluate the effectiveness of this patient-centered palliative nutrition care model.
Methodology :
A multi-disciplinary nutrition care algorithm was developed to guide the care-planning process. The guideline was circulated among physicians, nurses and dietitians. Nutritional care should be taken into account the stage of patient’s journey with focus on improving the patient’s sense of wellbeing, symptoms relief, food enjoyment and psychological support to relief eating related distress. Physician’s opinion was sought to provide care plan based on individualized problem identification, and goals agreed with patient and caregivers. In this study, dietitians and nurses assessed patients’ nutrition-related symptoms and food preferences. Small frequent meals, nourishing snacks or drinks on demand, and palliative nutrition leaflets were provided as appropriated. A simplified version of Patient Generated Subjective Global Assessment (PG-SGA) questionnaire was designed to assess patient’s weight, food intake, activities and nutrition-related symptoms. Each parameter has a scoring system; the higher the score represents a greater degree of severity. An additional question was added to assess the eating-related distress level of patients and main carers. Data was collected repeatedly at baseline and end of study. Wilcoxon signed rank test was used to analyze the significant difference within-group in pre and post intervention of this palliative nutrition care model
Result & Outcome :
A total of 69 in-patients (55% females) with the mean age of 66 years old completed the study. After provision of palliative nutritional care service, patient’s eating-related distress level (Z=-4.692, p<0.001) had significantly reduced- the mean distress level dropped from 2.8 at baseline to 1.1 at follow-up consultation. A significant reduction in the total number of symptoms (Z=-4.236, p<0.001) and symptom scores (Z=-3.461, p<0.001) were seen. When stratified by individual symptoms, nausea (Z=-3.0, p=0.003), dry mouth (Z=-2.0, p=0.046) and early satiety (Z=-2.711, p=0.007) were effectively relieved. Carers tend to have a higher distress score toward patient’s eating problem. This new patient-centered palliative nutrition care model was effective in relieving patient’s nutrition related discomfort both physically and emotionally, and identifying carer stress.
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