Incorporating Palliative Care Concepts Into Nutrition Practice: Across the Age Spectrum.

A practice gap exists between published guidelines and recommendations and actual clinical practice with life-sustaining treatments not always being based on the patient's wishes, including the provision of nutrition support therapies. Closing this gap requires an interdisciplinary approach that can be enhanced by incorporating basic palliative care concepts into nutrition support practice. In the fast-paced process of providing timely and effective medical treatments, communication often suffers and decision making is not always reflective of the patient's quality-of-life goals. The current healthcare clinical ethics model does not yet include optimum use of advance directives and early communication between patients and family members and their healthcare providers about treatment choices, including nutrition support. A collaborative, proactive, integrated process in all healthcare facilities and across levels of care and age groups, together with measurable sustained outcomes, shared best practices, and preventive ethics, will be needed to change the culture of care. Implementation of a better process, including basic palliative care concepts, requires improved communication skills by healthcare professionals. Formalized palliative care consults are warranted early in complex cases. An education technique, as presented in this article, of how clinicians can engage in critical and crucial conversations early with patients and family members, by incorporating the patient's values and cultural and religious diversity in easily understood language, is identified as an innovative tool.

The unlikely patient and the most likely patient: a personal reflection on 2 patients and the lessons learned regarding physician communication in the field of palliative medicine.

Palliative care is somewhat of a new field in medicine. A field which requires within it an intricate understanding of disease and its prognostic indicators. A field which considers the patient as a whole with the goal of patient-directed care. And a field which necessitates as much medicine as it does art. However, Palliative Care is often consulted by intensivists and primary teams during the last moments of life. And although we can be helpful during this time, we can be of more assistance when incorporated earlier by providing not only end-of-life care, but enhanced pain and symptomatic management, elucidating goals of care, as well as affording patients and their families with emotional, spiritual, and psychosocial support. Our expertise can be useful in all patients, not just the dying.