Hospice and long-term use of appetite stimulants

  1. Hello-
    I am so glad that I found this website. I am a registered dietitian working with a hospice organization in Athens, GA. I have been with the organization for a few months and have been doing mostly patient and family educations (high cal, high pro; diet strategies to reduce N/V and constipation, etc). I am trying to become more involved with the organization and thought looking at the use of appetite stimulants (cost effective?) might be a good idea. My question to you is how long should a hospice pt. be on an appetite stimulant? Our appetite stimulant of choice is Megace, however several are on Decardron for mets, and bone pain and receive the added benefit of appetite stimulation. Many of our patients are admitted to hospice on Megace with continued poor po intake and are left on it for months and months. Does anyone have a standard of practice for these meds or just guidelines that you go by for the use and duration. I appreciate all your help.
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  2. 6 Comments

  3. by   talaxandra
    Sorry I don't have any information about this for you, but welcome to allnurses!
  4. by   Tweety
    Welcome. Try posting in the hospice board and the general nursing board. You'll get more views and hopefully some response. Good luck.
  5. by   nursebedlam
    Hullo out there,, Welcome to allnurses, I do hope you enjoy your time here, look forward to reading your posts.....
  6. by   rehab nurse
    hello there~

    i work in a subacute rehab/transitional care facility attached to a nursing home. 99% of our patients arrive needing additional PT/OT/ST before returning to their previous living arrangements. with the patients who have underlying cancer, or those with poor appetitite, our docs and RD have usually used megace, and are now starting to use marinol as well. when we do get the occasional patient who is referred to hospice, they are usually taken off most of their meds. with patients who are admitted to long term care, i have seen maybe one or two patients who continue on megace, but it happens rarely. most of the hospice patients in our facility are off all meds, no more blood draws, testing, etc. a lot depends on the patient/family wishes. i don't think our docs would let the patient remain on megace for months and months if it was not effective and they are on hospice.
    but fyi, the marinol seems to be far more effective so far in the patients i have seen take it for appetite stimulation. megace, from what i have seen, works about half the time in our patients.

    heather
  7. by   renerian
    In my travels I have not seen much success with this med for that problem but I have seen Zoloft work very well to increase appetite. Being the cost effective person I am I cannot see keeping a patient on a med that does not work effectively for a long period of time.

    renerian
  8. by   stbernardclub
    The drug I see used most is megace, and with success. Once they are on hospice and declining, most medications are pulled except those for pain, increases secretions and resps. By then, it is usually unsafe for a pt to swallow food. Giving them a appetite stimulant in my opinion would be contraindicated.

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