Transitioning to oral feeding from other routes in the palliative care unit

Abstract

Aims:The evaluation of swallowing in the palliative care (PC) unit (PCU) is an important indicator of care. In this study, we investigated how an on-admission swallowing test in the PCU guides the course of the feeding route.Methods:This single-center, retrospective study included PC patients who underwent bedside swallowing evaluation. The main exclusion criteria were gastrointestinal failure requiring permanent parenteral nutrition, no swallowing test upon admission, and a length of stay shorter than four days. The primary endpoint was the proportion of patients with dysphagia who transitioned to oral feeding.Results:The study included 63 patients [age, median interquartile range: 80.0 (14) years (37 to 94 years); males: 54.0%]. Thirty-six (57.1%) of 63 admissions had dysphagia, whereas 27 (42.9%) patients had no dysphagia. The route of feeding was modified in 50.8% of the samples during their PCU stay. The proportion of patients who returned to oral feeding was 30.2% (n=19), whereas 6.3% (n=4) and 12.7% (n=8) of the sample underwent nasoenteral tube and percutaneous endoscopic gastrostomy (PEG) placement, respectively. Among the 32 patients who were on tube feeding on admission, 12 (37.5%) returned to oral feeding during their PCU stay. Seven (58.4%) of these subjects who regained oral feeding were on nasoenteral tube feeding and 5 (41.6%) were on PEG feeding on admission.Conclusions:This study showed a high rate of dysphagia on admission to the PCU. On the other hand, safe and adequate oral feeding could be re-initiated in almost one-third of patients with dysphagia on admission.

Keywords

• palliative care unit
• dysphagia
• swallowing test
• oral feeding
• enteral feeding