{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:11:12Z","timestamp":1789020672338,"version":"build-2803163510"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\nIntroduction<\/jats:title>\nTube feeding continues to be recommended for nutrition when a patient has dysphagia amid life-limiting illness. Tube feeding is frequently claimed to be a safer alternative to oral feeding. Oral feeding, including careful hand feeding, has emerged as a viable and evidence-based alternative for patients who desire nutrition at the end of life but have trouble swallowing. There is a critical need to determine the best option for a feeding route at the end of life. This novel, pilot, prospective study was conducted to contribute toward that need. This is the first study of its kind.<\/jats:p>\n<\/jats:sec>\n\nAims<\/jats:title>\nResearchers aimed to investigate the impact of feeding route (oral or tube) on patient outcomes, contributing to scientific knowledge as related to nutritional decision-making when patients are critically or terminally ill, desiring nutrition, and diagnosed with dysphagia.<\/jats:p>\n<\/jats:sec>\n\nMethods<\/jats:title>\nParticipants (N\u2009=\u200965) were admitted to a tertiary center, diagnosed with dysphagia and life-limiting illness, and treated by Palliative or Family Medicine. Data were collected as related to demographic (age, sex, race, ethnicity) and clinical statistics (mortality risk\/severity of illness, primary diagnoses, patient outcomes [pneumonia, depression, and mortality], and feeding route [oral and tube]). Logistic regression modeling (unadjusted and adjusted by mortality risk and age) and propensity score matching were used to analyze data.<\/jats:p>\n<\/jats:sec>\n\nResults<\/jats:title>\nResults indicated a greater likelihood of negative clinical outcomes as related to tube versus oral feeding. Findings challenge default use of tube feeding as a safer alternative for nutrition. Specifically, results revealed tube feeding to be significantly (p\u2009<\u20090.001) associated with increased risk of pneumonia (adjusted OR = 19.28, p\u2009<\u20090.01) and significantly (p\u2009<\u20090.001) associated with depression (adjusted OR = 17.25, p\u2009<\u20090.01), with mortality also trending higher (adjusted OR = 2.78, p\u2009=\u20090.147). Moreover, a composite outcome analysis (pneumonia, depression, or mortality) revealed impressively greater odds of an adverse event occurring due to tube versus oral feeding (adjusted OR = 55.64, p\u2009<\u20090.01), underscoring the need to consider further research and a possible paradigm shift in nutritional decision-making for palliative care patients. The propensity score analysis yielded balanced, matched groups (n\u2009=\u200930), 15 participants who were oral-fed and 15 who were tube-fed. Results also revealed significantly higher rates of pneumonia (p\u2009<\u20090.001) and depression (p\u2009=\u20090.035) in participants who received tube versus oral feeding. Again, mortality trended higher but significant results were not achieved.<\/jats:p>\n<\/jats:sec>\n\nClinical implications<\/jats:title>\nThese results have substantial clinical implications. Results support reconsidering routine tube feeding in favor of individualized, patient-centered approaches that prioritize quality of life and informed decision-making. This pilot study contributes to ongoing discussions about evidence-based palliative care and has the potential to influence guidelines on feeding practices for terminally-ill patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333895","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T17:45:37Z","timestamp":1759859137000},"page":"e0333895","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Rethinking tube feeding in palliative care: Impact on pneumonia, depression, and mortality in patients with dysphagia and life-limiting illness"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4695-1002","authenticated-orcid":true,"given":"Jennifer","family":"Hanners 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