Questions around fears

Quiz 1 of 4

QUESTION

“I couldn’t bear to think he is hungry and we are starving him”

CORRECT RESPONSES

• We will be closely watching and of course act on any signs that he is agitated due to hunger – good, explaining the focus of care is on maintaining comfort
• We plan to regularly offer tastes of food and see how he responds – good, explaining that comfort feeding will be tried
• Losing appetite is common and a normal part of dying – reassurance that the focus is on comfort rather than providing nutrition

INCORRECT RESPONSES

• I don’t think he will feel hungry – this doesn’t acknowledge their concerns

Quiz 2 of 4

QUESTION

“I thought you would keep a drip for fluids”

CORRECT RESPONSES

• We will closely watch and continue with fluids unless there are signs of discomfort with the drip or he becomes overloaded with fluids – good to explain the rationale for any decision
• Continuing with fluids can cause some problems with fluid overload. This will make breathing more difficult. We will look for signs that he is thirsty – good to explain the rationale for any decision

INCORRECT RESPONSES

• That would extend his suffering – this is not reassuring, the focus should be on good palliative care
• There is no point in keeping fluids running if we are not feeding him – this is not reassuring, the focus should be on good palliative care

Quiz 3 of 4

“But I’ve been told it is too risky to give him a drink. Now you are saying he can have this. What if he chokes?”

CORRECT RESPONSES

• Initially we were being cautious because of his difficulty swallowing as we wanted to give him every chance of improving – helpful to explain the change in management
• The priority now is keeping him comfortable. This can include helping him with sips and small tastes of food but we will continue to check on how he is coping with this and reduce his risk of choking – explaining the focus is on comfort feeding, not pushing nutritional intake
• The speech and language therapist and nurses will be checking how he is coping and you can ask them how best to help – it can be helpful for the family to be involved

INCORRECT RESPONSES

• We are not concerned about keeping his chest clear now – this is not re-assuring. The focus should be on good palliative care.

Quiz 4 of 4

“How long will it take – starving him to death?”

CORRECT RESPONSES

• I know it might feel like we are starving him because we are not replacing the feeding tube but we are now focusing on keeping him comfortable and we will see how he responds – acknowledge the emotion but re-focus on the purpose of care
• We will be checking for any signs of discomfort due to hunger and will be offering food and fluid as he is able. Timing is very difficult to predict as it depends on how he responds. Please tell us about anything you are concerned about and we will keep you up to date on any changes – important to address the emotive issue of starving. Estimated timings can be given if known.

INCORRECT RESPONSES

• How long is a piece of string? We can’t be sure – not reassuring: need to explain the focus is now on good palliative care

MAYBE

• This could take a long time, you should be prepared – although it can be reasonable to give estimations of time, it is important to address the emotional response to withdrawal of feeding.  “Long time” is not helpful to families – could mean days, week, months and needs to be more quantifiable to be a helpful statement.