PD747 - HOW CLINICIANS NAVIGATE ARTIFICIAL NUTRITION AND HYDRATION IN ADVANCED CANCER: A REVIEW OF BELIEFS AND PRACTICES

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PD747

HOW CLINICIANS NAVIGATE ARTIFICIAL NUTRITION AND HYDRATION IN ADVANCED CANCER: A REVIEW OF BELIEFS AND PRACTICES

J. Baker1,*, A. J. Gifford1, S. J. White1

1School of Allied Health Professions and Pharmacy, Keele University, Keele, United Kingdom

 

Rationale: The use of artificial nutrition and hydration (ANH) in advanced cancer is widely varied despite the presence of established clinical guidelines1,2. This literature review explored which clinician beliefs and perceptions influence ANH decision‑making and how these factors affect clinical practice.

Methods: A systematically structured review was conducted using searches of 4 bibliographic databases. Eligibility criteria were defined using the PICO framework and title/abstract screening, data extraction and quality appraisal performed.

Results: 11 studies using various methodological designs were included with three major themes were identified. The first was the impact of knowledge gaps; clinicians reported strong palliative care competence yet inconsistent understanding of ANH indications, risks and goals, contributing to late or inconsistent initiation and challenges around withdrawal. Secondly, ANH was commonly perceived as a symbol of care and hope, creating emotional and ethical tension when withholding or withdrawing treatment. Finally, practice varied according to professional role, ethical reasoning, cultural and religious norms, organisational constraints, and communication quality with patients and families.

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Conclusion: Clinician decision‑making about ANH in advanced cancer is shaped by a combination of knowledge limitations, symbolic meaning, ethical and cultural influences and communication barriers rather than evidence alone. These findings highlight persistent gaps between guideline recommendations and real‑world practice reinforcing the need for further research examining how clinicians interpret benefit, and navigate ethical complexity when considering ANH.

References:         1. Druml C et al. ESPEN guideline on ethical aspects of artificial nutrition and hydration. Clin Nutr. 2016;35:545–56.

        2. Muscaritoli M et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40:2898–913.

Disclosure of Interest: None declared