The use of artificial nutrition at the end-of-life : a cross-sectional survey exploring the beliefs and decision-making among physicians and nurses

Article Article scientifique Article The use of artificial nutrition at the end-of-life : a cross-sectional survey exploring the beliefs and decision-making among physicians and nurses eng 2025-03-17 2025-04 author Pala Christophe 0009-0005-4324-1319 Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals, 11 Chemin de La Savonnière, 1245 Collonge-Bellerive, Geneve, Switzerland. christophe.pala@hug.ch. 525987 author Gamondi Claudia 0000-0002-1537-9055 Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. author Eychmuller Steffen 0000-0003-1734-2237 University Centre for Palliative Care, Inselspital, University Hospital Bern, Bern, Switzerland. author Herrmann François 0000-0003-1312-1517 Department of Rehabilitation and Geriatrics, Division of Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. 70980 dept de réadaptation et gériatrie (MIGRG) author Pautex Sophie Marie 0000-0001-7248-3513 Department of Rehabilitation and Geriatrics, Division of Palliative Medicine, Geneva University Hospitals and Faculty of Medicine, Geneve, Switzerland. 37604 dept de réadaptation et gériatrie (MIGRG) 287 10.1007/s00520-025-09310-2 40095086 0941-4355 PMC11914226 https://link.springer.com/10.1007/s00520-025-09310-2 Background: The use of artificial nutrition in the last month of life raises many concerns for patients, relatives, and healthcare professionals. Aim: To describe physicians and nurses' beliefs, knowledge, and decision-making related to introducing and withdrawing artificial nutrition at the end-of-life. Physicians and nurses' factors affecting these decisions were examined. Design: A cross-sectional study was conducted between May and July 2022. A questionnaire was sent by email to physicians and nurses. Setting and participants: Physicians and nurses working in internal medicine, oncology, and palliative medicine divisions in three Swiss University Hospitals. Results: Two hundred and thirty physicians and nurses completed the survey (21% response rate). Most responders, aged 25-45, were women with < 10 years of experience, 61% lacked palliative care experience. End-of-life decision-making on artificial nutrition was reported as common by 89%. Whereas physicians and nurses played an important role in the decision, fulfilling patients' wishes (84% of cases) tended to dominate over professionals' intentions (physicians 52%, nurses 67%) as motivators at final decision. The main reasons for introducing artificial nutrition included improving nutritional status (54%), reducing broncho-aspiration (67%), and preventing pressure ulcers (53%). Having palliative care experience was the only variable modifying the beliefs of these motivations. Conclusion: Whereas decisions on artificial nutrition at the end of life are common they may be mostly guided by physicians and nurses' beliefs, and patients' requests more than by robust evidence. Fostering palliative care education is pivotal. Our results emphasize the need to improve physicians and nurses' awareness of the complex interplay between values and evidence when decisions concerning artificial nutrition are taken. Artificial feeding/nutrition Attitude of health personnel End-of-life Health personnel knowledge Palliative care Terminal care Dewey 618.97 65 Département de réadaptation et gériatrie 22B false 436 Médecine palliative 709 Supportive care in cancer 33 4 f5901d05-c731-4cfe-8188-d779ded83957 Article (Published version) Public Article_scientifique_from_unpaywall.pdf 659433 application/pdf CC BY-4.0 5a1db0b711ca67ed70492642d95eda14b84bfd8ee94c62a9ffe03e6e7ca79742 fa03e9be-679d-462d-aa50-bf53254781ba Supplemental data Public 520_2025_9310_MOESM1_ESM1.docx 33694 application/vnd.openxmlformats-officedocument.wordprocessingml.document a505441a30d1428fa530e04a4e8650c9af0808c71c63cb06ea2c8a2d27ffe7ec 73737d61-f66b-4022-86a7-79f0db3d3e4e Supplemental data Public 520_2025_9310_MOESM2_ESM.docx 33287 application/vnd.openxmlformats-officedocument.wordprocessingml.document c6eab68b1684869c06778d2738f289afcd906d4ed131efe2ae5753dadec21a69 d7c0a549-f3c1-4026-8bf2-7934320a37b1 Supplemental data Public 520_2025_9310_MOESM3_ESM.docx 37600 application/vnd.openxmlformats-officedocument.wordprocessingml.document 31d44f159ad74e79bdeab3b32f47848c128af9a8979da5b546218d144cc55521 8be3bd52-286f-4e20-ac52-a7d1b6a7c8e5 Supplemental data Public 520_2025_9310_MOESM4_ESM.docx 25684 application/vnd.openxmlformats-officedocument.wordprocessingml.document 6e21d8ac3a6da64fce417d6b5a9624e7db4596ba19610266f3ab3d194c3e572a openAccess Faculté de médecine / Section de médecine clinique / Département de réadaptation et gériatrie

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