The use of artificial nutrition at the end-of-life: a cross-sectional survey exploring the beliefs and decision-making among physicians and nurses.

Background: The use of artificial nutrition in the last month of life raises many concerns for patients, relatives, and healthcare professionals.

Aim: To describe physicians and nurses' beliefs, knowledge, and decision-making related to introducing and withdrawing artificial nutrition at the end-of-life. Physicians and nurses' factors affecting these decisions were examined.

Design: A cross-sectional study was conducted between May and July 2022. A questionnaire was sent by email to physicians and nurses.

Setting and participants: Physicians and nurses working in internal medicine, oncology, and palliative medicine divisions in three Swiss University Hospitals.

Results: Two hundred and thirty physicians and nurses completed the survey (21% response rate). Most responders, aged 25-45, were women with < 10 years of experience, 61% lacked palliative care experience. End-of-life decision-making on artificial nutrition was reported as common by 89%. Whereas physicians and nurses played an important role in the decision, fulfilling patients' wishes (84% of cases) tended to dominate over professionals' intentions (physicians 52%, nurses 67%) as motivators at final decision. The main reasons for introducing artificial nutrition included improving nutritional status (54%), reducing broncho-aspiration (67%), and preventing pressure ulcers (53%). Having palliative care experience was the only variable modifying the beliefs of these motivations.

Conclusion: Whereas decisions on artificial nutrition at the end of life are common they may be mostly guided by physicians and nurses' beliefs, and patients' requests more than by robust evidence. Fostering palliative care education is pivotal. Our results emphasize the need to improve physicians and nurses' awareness of the complex interplay between values and evidence when decisions concerning artificial nutrition are taken.