Background:

Parenteral nutrition (PN) may represent a valuable therapeutic tool in palliative care (PC) for patients with intestinal failure, provided that functional status is preserved and rigorous clinical criteria are applied. In Uruguay, no national guidelines currently exist to guide its use in PC, and real-world clinical practice in this context remains poorly characterized.

Objective:

To explore the gap between recommended clinical criteria and actual clinical practice regarding PN in PC from the perspective of Uruguayan physicians involved in nutritional therapy or palliative medicine.

Methods:

A descriptive, observational, cross-sectional study based on an anonymous self-administered survey conducted among physicians with experience in PC or nutritional therapy. A total of 78 complete responses were analyzed, assessing criteria used to indicate PN, perceived barriers, institutional access, and professional training.

Results:

A total of 43.6% of participants reported having treated patients who met ideal clinical criteria for PN; however, only 50% of these patients actually received the treatment. The main barriers were uncertainty about clinical benefit (46.2%), patient or family refusal (30.8%), and lack of infrastructure (30.8%). In addition, 55.2% of palliative care physicians and 66.7% of nutritional therapy specialists lacked recent cross-training in the complementary area. Over 65% reported that their institution did not have a formal protocol, and 98.7% considered that a national guideline is needed to standardize PN indication in PC.

Conclusions:

Relevant gaps were identified between theoretical recommendations and real-world clinical practice regarding PN in PC. Decision-making is influenced by educational, structural, and organizational barriers. These findings highlight the need for national guidelines and stronger interdisciplinary collaboration to ensure decisions consistent with the principles of proportionality, comfort, and patient dignity.

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