Recomendações nutricionais em cuidados paliativos para pacientes com doenças avançadas e no final da vida

Palliative care (PC) is based on a multidisciplinary approach to the patient and their family to prevent and alleviate the suffering of the patient, promoting and maintaining an optimal quality of life until death. Food plays a fundamental role in people’s lives. Beyond nutrition, the fact that dying people have anorexia as part of their symptoms is difficult to accept as it means admitting death. A multidisciplinary plan to nutrition is essential, adapting to the disease stage and always considering that the benefits must outweigh the possible adverse effects. As an integral part of PC, artificial nutrition and hydration (ANH) can increase survival and improve quality of life in selected patients based on their pathology. Therefore, nutritional support should be prescribed according to the patient’s disease stage, energy and protein requirements, analyzing tolerability, and above all, respecting the wishes of the patient, family or caregiver. It is essential to know the patient, family, or caregivers’ preferences and achieve efficient communication within the health team. By doing so, it is possible to reach a shared understanding of the goals of palliative treatment among all members involved. This narrative review aims to describe the general and specific nutritional recommendations in the advanced stage and at the end of life phase of some of the primary diseases in which PCs play a vital part in offering a complete treatment to these specific patientsLos cuidados paliativos (CP) se basan en un abordaje multidisciplinar del paciente y su familia para prevenir y aliviar el sufrimiento del paciente, al promover y mantener una óptima calidad de vida hasta la muerte. La alimentación desempeña un papel fundamental en la vida de las personas. Más allá de la nutrición, el hecho de que las personas moribundas tengan anorexia como parte de sus síntomas es difícil de aceptar, ya que significa admitir la muerte. Un plan multidisciplinar de nutrición es fundamental, que se adapte al estadio de la enfermedad, siempre considerando que los beneficios deben superar los posibles efectos adversos. Como parte integral de la CP, la nutrición e hidratación artificiales (NHA) pueden aumentar la supervivencia y mejorar la calidad de vida en pacientes seleccionados en función de su patología. Por tanto, el soporte nutricional debe prescribirse de acuerdo con el estadio de la enfermedad del paciente y los requerimientos energéticos y proteicos, analizando la tolerabilidad y, sobre todo, respetando los deseos del paciente, la familia y el cuidador. Es fundamental conocer sus preferencias y lograr una comunicación eficiente dentro del equipo de salud. Al hacerlo, es posible alcanzar un entendimiento compartido de los objetivos del tratamiento paliativo entre todos los miembros involucrados. Esta revisión narrativa tiene como objetivo describir las recomendaciones nutricionales generales y específicas en la etapa avanzada y al final de la vida de algunas de las enfermedades primarias en las que los CP desempeñan un papel vital para ofrecer un tratamiento completo a estos pacientes específicos.Palliative care (PC) is based on a multidisciplinary approach to the patient and their family to prevent and alleviate the suffering of the patient, promoting and maintaining an optimal quality of life until death. Food plays a fundamental role in people’s lives. Beyond nutrition, the fact that dying people have anorexia as part of their symptoms is difficult to accept as it means admitting death. A multidisciplinary plan to nutrition is essential, adapting to the disease stage and always considering that the benefits must outweigh the possible adverse effects. As an integral part of PC, artificial nutrition and hydration (ANH) can increase survival and improve quality of life in selected patients based on their pathology. Therefore, nutritional support should be prescribed according to the patient’s disease stage, energy and protein requirements, analyzing tolerability, and above all, respecting the wishes of the patient, family or caregiver. It is essential to know the patient, family, or caregivers’ preferences and achieve efficient communication within the health team. By doing so, it is possible to reach a shared understanding of the goals of palliative treatment among all members involved. This narrative review aims to describe the general and specific nutritional recommendations in the advanced stage and at the end of life phase of some of the primary diseases in which PCs play a vital part in offering a complete treatment to these specific patients