2024 Volume 28 Issue 3 Pages 169-175
The patient was a 22-year-old male with acute T-cell lymphoblastic leukemia. Owing to multiple relapses of the primary disease, the patient’s prognosis was poor. In addition, the patient developed severe dysphagia with salivary aspiration due to myelitis. Although the risk of aspiration pneumonia increases with oral intake, the patient and his family strongly desired oral feeding, leading to an ethical dilemma. After consulting with the attending physician and nurses, a decision was made to proceed with oral intake based on deliberation using the four quadrants. A unified approach was implemented to reduce the risk of aspiration pneumonia during oral intake. This included (1) oral care pre- and post-eating, (2) thorough suctioning, (3) compensatory approaches, and (4) risk management. The effect of oral intake on the patient’s mental state was assessed using the Profile of Mood States, which showed improvements in the categories “depression,” “anger,” “vigor,” “fatigue,” and “confusion.” Additionally, due to the unified approach during oral intake, there were no significant instances of aspiration pneumonia for the following 2 months until the patient was discharged. In this case, using the four quadrants for policy deliberation and unified approach during oral intake were considered beneficial interventions for this patient at the end of life.
