Authors (including presenting author) :
Lai KM(1), Lee H (2), Wong A (3), Lau KI (2), Leung YL (1), Yeung E (4), Siu ML (1),To WS (1)
Affiliation :
(1)Palliative Care Unit, Ruttonjee & Tang Shiu Kin Hospitals, (2)Dietetic Department, Ruttonjee & Tang Shiu Kin Hospitals, (3)Food Service Department, Ruttonjee & Tang Shiu Kin Hospitals, (4) Palliative Care, Hong Kong East Cluster
Introduction :
For patients receiving palliative care, food is not solely for sustenance, it is more than nourishment as a source of pleasure and a bonding with families. In July 2019, Palliative team joined hands with Dietetic Department and Food Services Department to evaluate to existing food supply, scheduling and logistics and seek for its improvement as to maximize the food enjoyment and hence improve the quality of life of palliative care patient.
Objectives :
To explore the preference of food, beverages and the existing therapeutic diet and the supplement of palliative patients.
To upgrade and maximize the existing food provision.
To broaden the variety of food choice and provide food based on safety rule.
Methodology :
Join meetings were held on 27th August, 26th September, 24th October, 21st November and 19th December 2019 for discussing and brainstorming strategies modification with the consideration of risk management. The followings were implemented since 2nd October 2019.
1. Broadened food varieties were offered during afternoon snack: (i) dim sum e.g. siu mai, radish cake, Cantonese sponge cake; (ii) Pudding e.g. sesame paste; (iii) Chinese soup (老火湯); (iv) apple puree topped with ginger sauce.
2. Condiments were served during meal time e.g. sesame oil, soy sauce (醬油) and fermented bean curd to enhance the flavor of meal.
3. Pu’er Tea (普洱)was served during lunch time as to decrease the greasy feeling of meal and mimic the traditional Chinese eating habit.
4. Proportion of carbohydrate in lunch and dinner were reduced (except for therapeutic diet) which aim to make meal portions less intimidating.
5. Carbohydrates, vegetables and meat dishes for pureed diet was partitioned for delicate outlook.
6. Various of formulated enteral supplement were stocked at ward to enrich patient’s choice at added evening milk round.
7. House- hold beverages were stocked at ward e.g. cane juice, apple juice, soya milk, malted soya drink for further extend patient’s choice of consumption at evening milk round.
8. Snacks and drinks were served with patterned cups and plates to refine to food presentation.
9. Leaflets on dietary advice was designed and color- printed for patients and their relatives as knowledge consolidation.
Result & Outcome :
91.7% of patients who are suitable for oral feeding accepted the offer of milk or house- hold beverage. Among the patients with the non- renal group, the top 3 famous choices are house- hold beverage (1st: apple juice, 32.6%; 2nd: cane juice, 21% and 3rd: Vitasoy soymilk, 11.6%) and all of those choices are well known and could be purchased easily from the market. For the patient in the renal group, their first 3 famous choices are 1st is apple juice (26.6%); 2nd is cane juice (20.9%) and 3rd is Renilon 7.5 Apricot flavor (11.6%). Surprisingly, most of the renal and non- renal patient prefers house- hold beverage than formulated nutritional supplement maybe due to the pursuing the “normality” within palliative patients’ mindset as to foster the sense of spiritual well- being. In addition, the Chinese cultural habit tends to absorb the nutrient and achieve the balanced diet from the food naturally rather than originated from the artificial formulation. Moreover, the packaging of the formulated nutritional supplement and message which delivered in the commercial material acted as the obstacle from choosing these kinds of product.
93% of orally feed patient agreed to receive the soup provided in this program. As discussed previously, the traditional Chinese tends to absorb and nourishes from the balanced diet and which also under the influence of the core idea of traditional Chinese medicine that theorized each person and its part of body own a balanced point of “yin and yang” and “qi” for optimal level of health. The Chinese tradition believes that the balance between “yin and yang” and “qi” can be corrected by the proper food such as hot soup.
92.4% of orally feed patient appreciated for the provision of dim sum and sweet soup. Chinese traditions prefer to take the snack or sweet soup between meal and after meal and it also explained the dim sum and sweet soup were the welcomed items within this program and the result consistent with the eating habit of the Chinese traditions.
85.7% of the patient who is suitable for oral feeding accepted the condiment. Fermented bean curd is the most popular choice (72.2%), followed by soy sauce (23.9%) and then is sesame oil (2.88%). The priority for the choice of condiments echoed with traditional eating habit.
Apart affirmative opinion from patients, there is numbers of encouraging feedback and appreciation were received from caregivers for program establishment.
