I happened upon this article while doing some research. While it is likely simply review of common knowledge and practice of experienced nurses in this field, I thought it was interesting and might be helpful for those new to hospice.
I particularly liked the fact that the article included some video examples of professional/patient interactions. The 7 steps outlined for having these discussions will, I think, reinforce what many of us are already doing and be informative for those new to these discussions.
I took care of a 59 year old man recently who had stg 4 pancreatic Ca. Because of his GI symptoms and anorexia he agreed to placement of a PEG tube within the last 2 months of his life. At time of our first meeting he told me that the tube did nothing to alleviate his symptoms and in fact the feedings made him feel worse. He was sorry that he ever had it put in because it changed nothing but cost him valuable time and comfort. In his opinion the tube made if more difficult for his family to let go of his nutrition and that made them all miserable as they revisited his eating and nutrition daily. I felt bad for him naturally, and spent a good deal of time with the family helping them to find peace in NOT putting things down the PEG tube.
Good luck out there my friends...keep on advocating for the dignity and comfort of these unfortunate people. We CAN help them, we just can't fix them.