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Palyatif Bakımda Beslenme Desteği: Diyetisyenin Kritik Rolü

Year 2025, Volume: 15 Issue: 3, 479 - 483, 24.09.2025
https://doi.org/10.33631/sabd.1590548

Abstract

Palyatif bakım; ciddi hastalıklarla mücadele eden bireylerde ağrı ile diğer fiziksel ve psikolojik problemleri erken tanıyıp, değerlendirip, tedavi ederek, hastalıklarla ilişkili problemleri önlemek ve rahatlatmak yoluyla, hastaların ve ailelerinin yaşam kalitesini düzeltme yaklaşımıdır. Palyatif bakım modelinin etkin bir şekilde işlemesi için multidisipliner bir ekip çalışmasının önemi büyüktür. Hastaların fiziksel, psikolojik ve sosyal ihtiyaçlarını karşılamak üzere bir araya gelen sağlık çalışanlarından oluşan ekipte yer alan diyetisyenlerin beslenme tedavisinin başlatılması, etkinliğinin değerlendirilmesi, izlenmesi, hastalığa bağlı oluşan beslenme sorunlarına yönelik beslenme planlarının yapılması gibi önemli görevleri bulunmaktadır. Palyatif bakımda yeterli beslenme desteğinin sağlanamamasının tıbbi tedavinin etkinliğini ve yaşam kalitesini olumsuz yönde etkileyerek morbidite ve mortalite oranlarını artırdığı bilinmektedir. Bu nedenle özellikle palyatif bakım sürecinde, diyetisyenlerin multidisipliner ekipteki etkin rolü, palyatif bakım hastalarının yaşam kalitelerini iyileştirmede ve tıbbi tedavinin etkinliğinde büyük öneme sahiptir.

References

  • World Health Organization. Palliative care essential facts [Internet]. Geneva: World Health Organization; 2020 [cited 2024 Oct 20]. Available from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/palliative-care/palliative-care-essential-facts.pdf
  • Del Olmo García MD, Moreno Villares JM, Álvarez Hernández J, Ferrero López MI, Bretón Lesmes I, Virgili Casas MN, et al. Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE. Nutr Hosp. 2022;39(4):936-44.
  • Yıldırım Y, Fadıloğlu Ç, editors. Palyatif Bakım: Semptom Yönetimi ve Yaşam Sonu Bakım. 2 nd ed. Ankara: Ankara Nobel Tıp Kitabevleri; 2022. p. 35-46.
  • Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining palliative care—a new consensus-based definition. J Pain Symptom Manage. 2020;60(4):754-64.
  • Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral nutrition by nasogastric tube in adult patients under palliative care: a systematic review. Nutrients. 2021;13(5):1562.
  • Tuncer Ö, Bayındır A. Malnutrition approach in the palliative care patients. Klin Tıp Aile Hek. 2016;8(3):11-4.
  • Bubis LD, Davis L, Mahar A, Li Q, Moody L, Barbera L, et al Symptom burden in the first year after cancer diagnosis: an analysis of patient-reported outcomes. J Clin Oncol. 2018;36(11):1103-11.
  • Hanks G, Cherny NI, Christakis NA, Kaasa S, Fallon M, Portenoy RK. The role of dietitian in palliative care. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford textbook of palliative medicine. Oxford: Oxford University Press; 2011. p. 219-25.
  • Kulick D, Deen D. Specialized nutrition support. Am Fam Physician. 2011;83(2):173-83.
  • Çınar H, Kaya Y, Enginyurt Ö. Effects of nutritional status on quality of life in palliative care patients. Bozok Tıp Derg. 2017;7(4):1-7.
  • Ruggeri E, Giannantonio M, Agostini F, Ostan R, Pironi L, Pannuti R. Home artificial nutrition in palliative care cancer patients: impact on survival and performance status. Clin Nutr. 2020;39(11):3346-53.
  • Lundholm K, Daneryd P, Bosaeus I, Körner U, Lindholm E. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism, and function. Cancer. 2004;100(9):1967-77.
  • Obling SR, Wilson BV, Pfeiffer P, Kjeldsen J. Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial. Clin Nutr. 2019;38(1):182-90.
  • Archer VR, Billingham LJ, Cullen MH. Palliative chemotherapy: no longer a contradiction in terms. Oncologist. 1999;4(6):470-7.
  • Yazıcı Ö, Ünal D. Palyatif bakım hastalarında beslenmenin önemi. Turkish J Oncol. 2021;35(1):86-9. https://doi.org/10.5505/tjo.2021.2659
  • Fernando G, Hughes S. Team approaches in palliative care: a review of the literature. Int J Palliat Nurs. 2019;25(9):444-51.
  • Ramanayake RP, Dilanka GV, Premasiri LW. Palliative care; role of family physicians. J Family Med Prim Care. 2016;5(2):234-7.
  • Hanson LC, Dobbs D, Usher BM, Williams S, Rawlings J, Daaleman TP. Providers and types of spiritual care during serious illness. J Palliat Med. 2008;11(6):907-14.
  • El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care. 2012;6(2):269-74.
  • Morris S, Wilmot A, Hill M, Ockenden N, Payne S. A narrative literature review of the contribution of volunteers in end-of-life care services. Palliat Med. 2013;27(5):428-36.
  • Rome RB, Luminais HH, Bourgeois DA, Blais CM. The role of palliative care at the end of life. Ochsner J. 2011;11(4):348-52.
  • Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 1998;12(5):317-32.
  • Fernando C, Hughes S. Team approaches in palliative care: a review of the literature. Int J Palliat Nurs. 2019;25(9):444-51.
  • Silbermann M, Pitsillides B, Al-Alfi N, Ben Yehuda A, Daher M, De Lima L, et al. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Ann Oncol. 2013;24(Suppl 7):vii41-7.
  • Bélanger E, Rodríguez C, Groleau D, Légaré F, MacDonald ME, Marchand R. Patient participation in palliative care decisions: an ethnographic discourse analysis. Int J Qual Stud Health Well-being. 2016;11:32438.
  • Pierzak M, Szczukiewicz-Markowska G, Głuszek S. The problem of hospital malnutrition and its consequences. Med Stud. 2020;36(1):46-50.
  • van der Riet P, Good P, Higgins I, Sneesby L. Palliative care professionals' perceptions of nutrition and hydration at the end of life. Int J Palliat Nurs. 2008;14(3):145-51.
  • Susan H. Importance of nutrition in palliative care of patients with chronic disease. Prim Health Care. 2011;21(6):48-56. https://doi.org/10.7748/ns2010.09.25.1.48.c7984
  • Pinto IF, Pereira JL, Campos CJ, Thompson JL. The dietitian’s role in palliative care: a qualitative study exploring the scope and emerging competencies for dietitians in palliative care. J Palliat Care Med. 2016;6(2):253.
  • Schindler K, Pernicka E, Laviano A, Howard P, Jonkers-Schuitema C, Kondrup J, et al. How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007–2008 cross-sectional nutritionDay survey. Clin Nutr. 2010;29(5):552-9.
  • Reber E, Norman K, Endrich O, Schuetz P, Frei A, Stanga Z. Economic challenges in nutritional management. J Clin Med. 2019;8(7):1005.
  • Schuetz P, Fehr R, Baechli V, Geiser M, Gomes F, Kutz A, et al. Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial. Int J Clin Trials. 2018;5(3):142-50.
  • Orrevall Y. Nutritional support at the end of life. Nutrition. 2015;31(4):615-6.
  • O'Hara PD. The management of nutrition in palliative care. Links Health Soc Care. 2017;2(1):21-38.
  • Maillet JO, Potter RL, Heller L. Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc. 2002;102(5):716-26.
  • Darmon P, Kaiser MJ, Bauer JM, Sieber CC, Pichard C. Restrictive diets in the elderly: never say never again?. Clin Nutr. 2010;29(2):170-4.
  • Shaw C, Eldridge L. Nutritional considerations for the palliative care patient. Int J Palliat Nurs. 2015;21(1):7-15.
  • Muscogiuri G, Barrera L, de los Ángeles Carignano M, Ceriani F. Nutritional recommendations in palliative care for patients with advanced diseases and at the end of life. Rev Nutr Clin Metabol. 2021;4(2):59-70.
  • Schütte K, Middelberg-Bisping K, Schulz C. Nutrition and gastroenterological support in end of life care. Best Pract Res Clin Gastroenterol. 2020;48-49:101692.
  • Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016;35(3):545-56.

Nutritional Support in Palliative Care: The Dietitian's Critical Role

Year 2025, Volume: 15 Issue: 3, 479 - 483, 24.09.2025
https://doi.org/10.33631/sabd.1590548

Abstract

Palliative care is an approach aimed at improving the quality of life for patients and their families by identifying, assessing, and treating pain and other physical and psychological problems early in individuals struggling with serious illnesses, and preventing and alleviating disease-related problems. The effective functioning of the palliative care model greatly depends on the importance of a multidisciplinary team approach. Dietitians, as part of the healthcare team formed to meet the physical, psychological, and social needs of patients, play critical roles in initiating nutrition therapy, evaluating its effectiveness, monitoring progress, and creating nutrition plans for addressing disease-related nutritional problems. It is well known that failure to provide adequate nutritional support in palliative care negatively impacts the effectiveness of medical treatment and quality of life, leading to increased morbidity and mortality rates. Therefore, especially during the palliative care process, the active role of dietitians in the multidisciplinary team is crucial in improving the quality of life for palliative care patients and enhancing the effectiveness of medical treatment.

References

  • World Health Organization. Palliative care essential facts [Internet]. Geneva: World Health Organization; 2020 [cited 2024 Oct 20]. Available from: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/palliative-care/palliative-care-essential-facts.pdf
  • Del Olmo García MD, Moreno Villares JM, Álvarez Hernández J, Ferrero López MI, Bretón Lesmes I, Virgili Casas MN, et al. Nutrición en cuidados paliativos: resumen de recomendaciones del Grupo de Trabajo de Ética de la SENPE. Nutr Hosp. 2022;39(4):936-44.
  • Yıldırım Y, Fadıloğlu Ç, editors. Palyatif Bakım: Semptom Yönetimi ve Yaşam Sonu Bakım. 2 nd ed. Ankara: Ankara Nobel Tıp Kitabevleri; 2022. p. 35-46.
  • Radbruch L, De Lima L, Knaul F, Wenk R, Ali Z, Bhatnaghar S, et al. Redefining palliative care—a new consensus-based definition. J Pain Symptom Manage. 2020;60(4):754-64.
  • Sánchez-Sánchez E, Ruano-Álvarez MA, Díaz-Jiménez J, Díaz AJ, Ordonez FJ. Enteral nutrition by nasogastric tube in adult patients under palliative care: a systematic review. Nutrients. 2021;13(5):1562.
  • Tuncer Ö, Bayındır A. Malnutrition approach in the palliative care patients. Klin Tıp Aile Hek. 2016;8(3):11-4.
  • Bubis LD, Davis L, Mahar A, Li Q, Moody L, Barbera L, et al Symptom burden in the first year after cancer diagnosis: an analysis of patient-reported outcomes. J Clin Oncol. 2018;36(11):1103-11.
  • Hanks G, Cherny NI, Christakis NA, Kaasa S, Fallon M, Portenoy RK. The role of dietitian in palliative care. In: Doyle D, Hanks G, Cherny NI, Calman K, editors. Oxford textbook of palliative medicine. Oxford: Oxford University Press; 2011. p. 219-25.
  • Kulick D, Deen D. Specialized nutrition support. Am Fam Physician. 2011;83(2):173-83.
  • Çınar H, Kaya Y, Enginyurt Ö. Effects of nutritional status on quality of life in palliative care patients. Bozok Tıp Derg. 2017;7(4):1-7.
  • Ruggeri E, Giannantonio M, Agostini F, Ostan R, Pironi L, Pannuti R. Home artificial nutrition in palliative care cancer patients: impact on survival and performance status. Clin Nutr. 2020;39(11):3346-53.
  • Lundholm K, Daneryd P, Bosaeus I, Körner U, Lindholm E. Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism, and function. Cancer. 2004;100(9):1967-77.
  • Obling SR, Wilson BV, Pfeiffer P, Kjeldsen J. Home parenteral nutrition increases fat free mass in patients with incurable gastrointestinal cancer. Results of a randomized controlled trial. Clin Nutr. 2019;38(1):182-90.
  • Archer VR, Billingham LJ, Cullen MH. Palliative chemotherapy: no longer a contradiction in terms. Oncologist. 1999;4(6):470-7.
  • Yazıcı Ö, Ünal D. Palyatif bakım hastalarında beslenmenin önemi. Turkish J Oncol. 2021;35(1):86-9. https://doi.org/10.5505/tjo.2021.2659
  • Fernando G, Hughes S. Team approaches in palliative care: a review of the literature. Int J Palliat Nurs. 2019;25(9):444-51.
  • Ramanayake RP, Dilanka GV, Premasiri LW. Palliative care; role of family physicians. J Family Med Prim Care. 2016;5(2):234-7.
  • Hanson LC, Dobbs D, Usher BM, Williams S, Rawlings J, Daaleman TP. Providers and types of spiritual care during serious illness. J Palliat Med. 2008;11(6):907-14.
  • El Nawawi NM, Balboni MJ, Balboni TA. Palliative care and spiritual care: the crucial role of spiritual care in the care of patients with advanced illness. Curr Opin Support Palliat Care. 2012;6(2):269-74.
  • Morris S, Wilmot A, Hill M, Ockenden N, Payne S. A narrative literature review of the contribution of volunteers in end-of-life care services. Palliat Med. 2013;27(5):428-36.
  • Rome RB, Luminais HH, Bourgeois DA, Blais CM. The role of palliative care at the end of life. Ochsner J. 2011;11(4):348-52.
  • Hearn J, Higginson IJ. Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliat Med. 1998;12(5):317-32.
  • Fernando C, Hughes S. Team approaches in palliative care: a review of the literature. Int J Palliat Nurs. 2019;25(9):444-51.
  • Silbermann M, Pitsillides B, Al-Alfi N, Ben Yehuda A, Daher M, De Lima L, et al. Multidisciplinary care team for cancer patients and its implementation in several Middle Eastern countries. Ann Oncol. 2013;24(Suppl 7):vii41-7.
  • Bélanger E, Rodríguez C, Groleau D, Légaré F, MacDonald ME, Marchand R. Patient participation in palliative care decisions: an ethnographic discourse analysis. Int J Qual Stud Health Well-being. 2016;11:32438.
  • Pierzak M, Szczukiewicz-Markowska G, Głuszek S. The problem of hospital malnutrition and its consequences. Med Stud. 2020;36(1):46-50.
  • van der Riet P, Good P, Higgins I, Sneesby L. Palliative care professionals' perceptions of nutrition and hydration at the end of life. Int J Palliat Nurs. 2008;14(3):145-51.
  • Susan H. Importance of nutrition in palliative care of patients with chronic disease. Prim Health Care. 2011;21(6):48-56. https://doi.org/10.7748/ns2010.09.25.1.48.c7984
  • Pinto IF, Pereira JL, Campos CJ, Thompson JL. The dietitian’s role in palliative care: a qualitative study exploring the scope and emerging competencies for dietitians in palliative care. J Palliat Care Med. 2016;6(2):253.
  • Schindler K, Pernicka E, Laviano A, Howard P, Jonkers-Schuitema C, Kondrup J, et al. How nutritional risk is assessed and managed in European hospitals: a survey of 21,007 patients findings from the 2007–2008 cross-sectional nutritionDay survey. Clin Nutr. 2010;29(5):552-9.
  • Reber E, Norman K, Endrich O, Schuetz P, Frei A, Stanga Z. Economic challenges in nutritional management. J Clin Med. 2019;8(7):1005.
  • Schuetz P, Fehr R, Baechli V, Geiser M, Gomes F, Kutz A, et al. Design and rationale of the effect of early nutritional therapy on frailty, functional outcomes and recovery of malnourished medical inpatients trial (EFFORT): a pragmatic, multicenter, randomized-controlled trial. Int J Clin Trials. 2018;5(3):142-50.
  • Orrevall Y. Nutritional support at the end of life. Nutrition. 2015;31(4):615-6.
  • O'Hara PD. The management of nutrition in palliative care. Links Health Soc Care. 2017;2(1):21-38.
  • Maillet JO, Potter RL, Heller L. Position of the American Dietetic Association: ethical and legal issues in nutrition, hydration, and feeding. J Am Diet Assoc. 2002;102(5):716-26.
  • Darmon P, Kaiser MJ, Bauer JM, Sieber CC, Pichard C. Restrictive diets in the elderly: never say never again?. Clin Nutr. 2010;29(2):170-4.
  • Shaw C, Eldridge L. Nutritional considerations for the palliative care patient. Int J Palliat Nurs. 2015;21(1):7-15.
  • Muscogiuri G, Barrera L, de los Ángeles Carignano M, Ceriani F. Nutritional recommendations in palliative care for patients with advanced diseases and at the end of life. Rev Nutr Clin Metabol. 2021;4(2):59-70.
  • Schütte K, Middelberg-Bisping K, Schulz C. Nutrition and gastroenterological support in end of life care. Best Pract Res Clin Gastroenterol. 2020;48-49:101692.
  • Druml C, Ballmer PE, Druml W, Oehmichen F, Shenkin A, Singer P, et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016;35(3):545-56.
There are 40 citations in total.

Details

Primary Language English
Subjects Health Services and Systems (Other)
Journal Section Reviews
Authors

Kadriye Toprak 0000-0001-8706-8689

İlknur Gökçe Yıldırım 0000-0001-8788-2242

Ebru Ozler 0009-0000-3303-3077

Publication Date September 24, 2025
Submission Date November 25, 2024
Acceptance Date June 12, 2025
Published in Issue Year 2025 Volume: 15 Issue: 3

Cite

Vancouver Toprak K, Yıldırım İG, Ozler E. Nutritional Support in Palliative Care: The Dietitian’s Critical Role. VHS. 2025;15(3):479-83.