Support the Person - Nutrition and Hydration - Managing Risk

Support the Person

Support the person to make food and drink choices even where it presents risk to them.

  • Failing to respect the person’s right to dignity of risk when eating and drinking, and making food and drink choices.
  • Denying the person enjoyment of food and drink.
  • The person not understanding the risks of decisions relating to food and drink choices, with consequent discomfort or pain.
  • Ensure the person (or their substitute decision-maker) is provided with relevant information about risks associated with eating or drinking.
  • Document discussions and decisions that may be inconsistent with health professional advice or present certain risks to the person.
  • Educate and empower staff about the importance of supporting choice.
  • Implement evidence based processes to manage swallowing and choking risks.
  • Review incident reports to identify whether risk mitigation strategies are effective or if they need adjustment.
  • Check that the person and others involved in decision-making relating to their care have the information they need to make decisions, and that they feel heard.
  • Undertake reflective practice to assess staff understanding of supporting choice and documenting acknowledgement of risk.

Needs and preferences will likely change during the palliative phase

A focus in the palliative phase is about quality of life including comfort, symptom relief and enjoyment of food rather than adhering to specific dietary restrictions.3

One of the challenges when managing nutrition and hydration at the end of life is respecting the person’s choices while also meeting responsibilities to provide safe and quality care.

For example, the person may want to:

  • continue eating their preferred food despite an assessed risk of choking or aspiration
  • avoid a modified diet even though it may help them intake and digest their food more easily
  • enjoy foods that would normally be considered unhealthy
  • eat foods not recommended for their current disease or illness (e.g. someone with kidney failure wanting to drink alcohol and eat salty chips).

Risk should be discussed and documented

Where the person’s choices pose risks to them, the risks should be discussed with them so that they can make an informed choice. They should then be supported to eat and drink in the way that gives them quality of life and enjoyment, while also mitigating risk as far as possible.

Robust processes that document the steps taken to recognise risks, enable informed decision-making, and identify possible mitigation measures allow the person to exercise their right to dignity of risk (see box).

Supporting a person to make choices even where it presents risk to them

Health care professionals can respond to a person’s expressed choice to eat or drink despite an acknowledged risk by supporting an informed decision-making process and documenting this.

A UK resource, Eating and drinking with acknowledged risks: Multidisciplinary team guidance for the shared decision-making process (adults) provides an indicative framework for assessment, decision-making, review and documentation processes to support health professionals to manage choices that pose risk.

Page updated 30 January 2024