Nutrition in palliative care at the end of life: Bibliometric and network analysis until 2024

Food consumption is not only driven by a desire for nutrients and satiety but also a fundamental element of human interaction. This study aimed to comprehensively analyze bibliometric characteristics, collaboration networks, points of interest, and research trends, providing insights into the current landscape of publications on nutrition in palliative care at the end of life (PC-EOL).

The Web Wof Science Core Collection database was screened for studies addressing PC-EOL, published until December 2024. From the search results, we performed statistical descriptions of the year of publication, study type, authors, country, institution, keywords, scientific journal, citations, and disciplinary (Web of Science category). VOSviewer 1.6.19 (visualization of similarities), Microsoft Office Excel 16.78 for Mac, BibExcel, and the Bibliometrix R package, along with the Biblioshiny tool, were used for data analysis.

Three hundred fourteen articles from 48 countries were included. Annual publications increased from 4 in 1994 to a peak of 35 in 2022 but declined over the past 2 years, reaching 16 in 2024. Most articles were from the United States, but the United Kingdom had the highest influence on the network. Keywords were stratified into 9 clusters: "Comprehensive End of Life Care," "Ethics and Decision-Making in End-of-Life," "Eating Disorders and Assisted Dying," "Palliative and Long-Term Care," "Palliative and Long-Term Care," "Advanced Nutritional Support," "Critical Care," "Family and Pediatric Care," "Advanced Cancer Management," and "Gastrointestinal Obstruction." Trend topic analysis suggests an increase in terms related to patients' refusal of nutrition/artificial nutrition, ethics, family, bereavement, and eating disorders, shifting from prior main themes, such as withdrawal/withholding life-sustaining therapy in advanced cancer/dementia. Among the top 20 cited articles, although all addressed nutrition in PC-EOL, it was the core element in only 9.

The number of articles published annually remains limited, with low levels of collaboration among countries and authors. Few studies have examined the symbolic and relational meanings of food in terminal illness from the perspectives of patients and their families, dimensions crucial to truly person-centered care. Future research should prioritize the lived experiences, cultural contexts, and ethical concerns of those directly affected.