Rethinking tube feeding in palliative care: Impact on pneumonia, depression, and mortality in patients with dysphagia and life-limiting illness.

INTRODUCTION

Tube feeding continues to be recommended for nutrition when a patient has dysphagia amid life-limiting illness. Tube feeding is frequently claimed to be a safer alternative to oral feeding. Oral feeding, including careful hand feeding, has emerged as a viable and evidence-based alternative for patients who desire nutrition at the end of life but have trouble swallowing. There is a critical need to determine the best option for a feeding route at the end of life. This novel, pilot, prospective study was conducted to contribute toward that need. This is the first study of its kind.

AIMS: Researchers aimed to investigate the impact of feeding route (oral or tube) on patient outcomes, contributing to scientific knowledge as related to nutritional decision-making when patients are critically or terminally ill, desiring nutrition, and diagnosed with dysphagia.

METHODS

Participants (N = 65) were admitted to a tertiary center, diagnosed with dysphagia and life-limiting illness, and treated by Palliative or Family Medicine. Data were collected as related to demographic (age, sex, race, ethnicity) and clinical statistics (mortality risk/severity of illness, primary diagnoses, patient outcomes [pneumonia, depression, and mortality], and feeding route [oral and tube]). Logistic regression modeling (unadjusted and adjusted by mortality risk and age) and propensity score matching were used to analyze data.

RESULTS

Results indicated a greater likelihood of negative clinical outcomes as related to tube versus oral feeding. Findings challenge default use of tube feeding as a safer alternative for nutrition. Specifically, results revealed tube feeding to be significantly (p < 0.001) associated with increased risk of pneumonia (adjusted OR = 19.28, p < 0.01) and significantly (p < 0.001) associated with depression (adjusted OR = 17.25, p < 0.01), with mortality also trending higher (adjusted OR = 2.78, p = 0.147). Moreover, a composite outcome analysis (pneumonia, depression, or mortality) revealed impressively greater odds of an adverse event occurring due to tube versus oral feeding (adjusted OR = 55.64, p < 0.01), underscoring the need to consider further research and a possible paradigm shift in nutritional decision-making for palliative care patients. The propensity score analysis yielded balanced, matched groups (n = 30), 15 participants who were oral-fed and 15 who were tube-fed. Results also revealed significantly higher rates of pneumonia (p < 0.001) and depression (p = 0.035) in participants who received tube versus oral feeding. Again, mortality trended higher but significant results were not achieved.

CLINICAL IMPLICATIONS: These results have substantial clinical implications. Results support reconsidering routine tube feeding in favor of individualized, patient-centered approaches that prioritize quality of life and informed decision-making. This pilot study contributes to ongoing discussions about evidence-based palliative care and has the potential to influence guidelines on feeding practices for terminally-ill patients.