- Impermanence is painful when we deny it. However, accepting the reality of impermanence can be a great comfort.
- Ultimately the only thing that can help is the state of our mind, the state of our mental or spiritual development.
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Anyone fortunate enough to be called to care for someone anxious about death or facing a critical illness must remember all of the following duties:
- Aleviate pain
- Treat illness if possible
- Allay anxiety.
- On many occassions, parenteral nutrition support may improve quality of life, even where the primary diagnosis cannot be cured.
- It is important to evaluate each case independently to see how and where parenteral support can be used most effectively to achieve patient's goals.
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If prognosis is
- Medical providers often find predicting prognosis challenging.
- There are sometimes (but not always) insurance limitations for PN coverage depending with hospice in place.
- Communicate with palliative care team and primary team re: prognosis, goals of care and role of HPN team in management.
- Often HPN team will NOT be the first call for emergencies, unlike standard HPN discharge.
- Ensure patient & family understand realistic expectations from parenteral support.
- Also ensure patient & family understand have good understanding of risks and responsibilities associated with parenteral therapy.
- When patients have very poor prognosis, HPN discharge teaching may need to be tailored to goals of care, especially if hospice nursing in place.
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Bear AJ, Bukowy EA, Patel JJ. Artificial Hydration at the End of Life. Nutr Clin Pract. 2017 Oct;32(5):628-632. doi: 10.1177/0884533617724741. Epub 2017 Aug 16. PubMed PMID: 28813202.
Hoda D, Jatoi A, Burnes J, Loprinzi C, Kelly D. Should patients with advanced, incurable cancers ever be sent home with total parenteral nutrition? A single institution's 20-year experience. Cancer. 2005 Feb 15;103(4):863-8. PubMed PMID: 15641035.