Nutritional support for the terminally ill patient: attitudes and ethics education of dietitians

Abstract

This study was conducted to investigate attitudes of dietitians regarding ethical dilemmas surrounding nutritional support for terminally ill patients. In addition, the methods and adequacy of ethics training received in dietetics education and in supervised experience programs, such as the Approved Preprofessional Practice Program (AP4), Coordinated Program in Dietetics (CPD), dietetic internship (DI), or any other experience approved by the American Dietetic Association (ADA), was researched.

A mailed questionnaire was sent to 147 dietitians living in Virginia with one to three years of clinical experience. Of the 144 deliverable questionnaires, 104 (72.2%) were returned, and results were tabulated. Data analysis included descriptive analyses, Pearson's correlation coefficient tests and analysis of variance (ANOVA) of selected variables.

Results indicated that the majority of the dietitians surveyed were women younger than 40 years old who reasoned contextually in decisions regarding termination of nutritional support, had little or no formal ethics education, and held either bachelor's or master's degrees. Dietitians who felt more confident with making ethical decisions were significantly more contextually influenced in nutritional support decisions than those who were somewhat, or not at all, confident. Those who said they brought spiritual beliefs to bear to a great extent in ethical decision making used more absolute principles in their decision-making. There were no differences in attitudes or ethics training relative to which supervised experience was completed, or to the highest degree attained.

Most dietitians have not had formal ethics training, and they are not confident in ethical decision-making. Therefore, dietetics education may need to focus on ethics training to enable future dietitians to effectively deal with ethical dilemmas they will face in their professional lives.