appetite stimulants in hospice

[dalmos]

What is the general opinion re the use of appetite stimulants in newly admitted hospice patients. I am well aware of normal nutritional changes associated with end of life progression, however, is there any benefit using appetite stimulants to either improve patient's perceived quality of life or provide some initial emotional support to family members having a difficult time making the transition to hospice?

thanks........

[Nonick9700]

I feel it's benefitting the family in most cases.

[SoCalRN1970]

benefit the family in most cases. Some patients ask for it, but usually it's under pressure from family who is concerned about . Many cultures have a hard time regarding nutritional and feeding terminally ill. Sick = feed = get stronger.

[Hospice Nurse LPN, BSN, RN]

Here's another "agree that it's for the family" vote. If they have it and want to continue w/ it that's not a problem. If they ask for it I explain the body's need for less nutrition @ the EOL. If they still want it, I'll get them an order, but let them know that hospice doesn't cover the cost of this med.

[Whispera, MSN, RN]

I wonder if there's some benefit to giving the meds to keep the patient a tad more alert, as well as possibly stimulating appetite. I wonder what research says about the benefits vs. negatives.

We often medicate for the family in Hospice. If the medication does no harm, and everyone understands what it's for, what it can do, what it can't do, I see no harm...

[leslie :-D]

i don't like using them as i feel it opposes the natural progession of the disease process.

they seldom work, and when they do, they inevitably cause more discomfort for the pt.

med regimens are constantly being changed or adjusted in hospice...

but they should reflect new/increasing symptomology that'll address the symptoms at hand, versus creating add'l symptoms.

i really wish they'd legalize medicinal marijuana (smoking form) since that seems to help many dying pts.

leslie

[tewdles, RN]

We frequently take advantage of the increased appetite that often accompanies a healthy dose of steroids...while palliating other symptoms.

[LMTRN]

My hospice does NOT cover Megace. If people are hungry, they'll eat, even if it's just a bite or two. Educating the family is the most important thing at this point.

[eternalsunshine]

I think it depends on the patient and if they actually want to eat. Toward end of life, giving food can actually cause more discomfort with bloating, cramping etc. The body does not need food at this stage. However if they are still wanting to try and eat, Dexamethasone is something that I have seen used, doesn't always work though, depends again on the individual.

Sometimes, it's better to educate the family and help them understand that it is the body's natural progression, as Leslie mentions, sometimes giving steroids etc. is kind of going against the body's natural course.