Dietitians

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [4] It is useful well before death and not limited to care of the dying. [5]

In helping people with palliative care needs, a dietitian: [5-9]

• recognises that eating has an emotional, social and cultural significance and that changes in food intake may be distressing for the person, family and carers
• assesses the person’s symptoms which may interfere with appetite or eating and their sense of what is important
• creates with the person realistic goals and expectations to enhance quality of life in the face of decline and impending death within the context of a therapeutic relationship
• assesses the person’s
  • diet or changes in diet
  • understanding of nutrition and relevance for quality of life
  • need for nutritional supplements
  • help or lack of help from a carer or carer network
• supports the multidisciplinary team with the nutritional management of symptom-related problems such as loss of appetite, altered taste and smell, dysphagia or cachexia
• can facilitate discussions on the potential benefits and burdens of supplemented oral, enteral and parenteral nutrition
• advises on preparation / fortification / supplementation / relaxation of previous dietary restrictions as appropriate for the person
• helps with the management of digestive issues, such as poor appetite, nausea or constipation
• educates the person and carers about safe eating and changes with deterioration
• works closely with the interdisciplinary team to ensure psychological and emotional support is provided, as required
• works closely with a speech pathologist, who will assess and address eating and swallowing problems.

Dietitians may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

Dietitians Association of Australia (DAA) have published the Role Statement for Accredited Practising Dietitians practising in the area of Oncology [8]

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [10] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [11]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

Using evidence

Although dietitians are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

The International Centre for Allied Health Evidence at University of South Australia has a number of resources to support translation of evidence into practice.

Guidelines

Guidelines specific to dietitians and palliative care in Australia have not been published, however, the Palliative Care Service Development Guidelines 2018 (340kb pdf) provides an overview of dietitians (as part of allied health) in specialist palliative care. [11]

Guidelines for the role of dietitians in the nutritional management of cancer have been developed:

• ESPEN guidelines on nutrition in cancer patients (2016) from ESPEN Guidelines & Consensus Papers (European Society for Clinical Nutrition and Metabolism)
• Updated Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy (2013) (Dietitians Association of Australia)
• Evidence-based practice guidelines for the nutritional management of adult patients with head and neck cancer (2018)
  • Clinical Question: What is the role for the dietitian in the management of patients with head and neck cancer requiring palliative care? (Wiki.cancer.org.au)
• Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient (2016) - Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition (ASPEN)
• Trace element supplementation for parenteral nutrition guidelines (536kb pdf) - AuSPEN 2014

Resources for Patients, Carers and Families

Dietitians have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers and Families provides links to useful information including fact sheets and printable resources Dietitians can download and share.

Education

The National Palliative Care Strategy 2018 lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [12] This is also highlighted for the acute sector in the Guiding Principles of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [13]

Courses

CareSearch lists a collection of Palliative Care eLearning resources for allied health for independent learning.