[Surveillance on fundamental principles in home artificial nutrition]

Artificial nutrition has been seen by clinicians as a medical treatment that patients or their surrogates may accept or refuse on the basis of the same considerations that guide other treatment decisions. However, public disagreement has arisen in the last times in relationship with some cases on the media.

In order to know the position of the members of the Nutrition Support teams in Spain a questionnaire based on two clinical scenarios was developed. A sample was sent by E-mail to all the members of the National Society. Data are presented as percentage. Comparison between groups was done by Chi square.

62 surveys were analyzed (65% physicians, 18% pharmacists; 12% nurses; 5% dietitians). 42% were 45 to 55 years old. Although a majority were working in clinical nutrition > 10 years, they considered themselves with insufficient bioethical background. In the case of Home Parenteral Nutrition--HPN-(45 yo lady with intractable ovarian cancer and intestinal obstruction), 77% agreed on HPN if the patient clinical condition was stable and she had strong family support. 75% answered that the main goal was to keep her at home as longer as possible. 92% considered that a mayor complication or a decrease in functions would contraindicate its use. 91% would review the decision periodically. In the case of Home Enteral Nutrition--HEN--(an old lady with progressive cognitive impairment needing a tube for feedings) 98% would indicate a gastrostomy tube. 77% considered HEN as a basic care, but if the patient had needed mechanical restriction only 41% would pursue in the decision.

Most of the health care workers in the Nutrition Support teams considered that the decision on starting artificial nutrition should be done in an individualized basis, and need a periodical re-evaluation. HEN was mostly considered as a basic care. There were no significant differences if answers were analyzed by profession, gender, working experience or personal value.