Topical Area: Medical Nutrition
Objectives : To compare differences in attitudes, beliefs and knowledge of Voluntary Refusal of Foods and Fluids among disciplines and health care providers. This project is of a comparative nature in keeping with One Health paradigms, and the first of its kind.
Methods : A cross-sectional, incentivized, email survey of human health care providers, veterinary personnel, professional caregivers and lay persons. Questionnaire development through sequential focus groups of experts in palliative care was validated, piloted and revised accordingly. Data was acquired through Qualtrics, and analyzed with Nvivo and SPSS. Descriptives, correlations and regressions were employed, along with other non-parametric methods for analyses. The research was approved by IRB and Human Subjects Committees at the primary institution where the research was conducted.
Results : The demographics significantly correlated with parameters of Voluntary Refusal of Foods and Fluids (VRFF) were religiosity, education and profession. Interestingly, geographic locale, method of Artificial Nutrition and Hydration (ANH), and “patient wishes” were not influential. There was a lack of uniformity in decision-making. Age was inversely related to institution of ANH in VRFF (p< 0.001). Veterinary personnel showed far greater fiscal conservancy for treatment of VRFF (p< 0.01), and were more willing to try ANH with poor prognoses (p< 0.05) versus human healthcare providers. Caregivers were far more likely to oppose intervention in patients with VRFF (p< .0.01).
Etiology leading to VRFF was most important, as was experience with health care, death, ethics and technological advancement. Limitations include inability to show causality with cross sectional data. Further research on end of life decisions is required in light of the burgeoning geriatric population worldwide among both the human and companion animal populations. It is of great importance to conduct cross disciplinary research when an area of study is in its infancy, as is the case with VRFF.
Funding Sources : The project was funded through a foundation grant from Bridges to a Cure.