Integral approach

Patient information 

• Provide information regarding the possible causes of nausea and vomiting, relevant factors, and the expected duration, in language that is easy for the patient to understand. The potential risks, symptoms, consequences and risks of dehydration should also be mentioned. Check if the patient has understood the information 
• Provide information regarding the objective, effect, possible side effects of treatment with antiemetics and taking antiemetics correctly 
• Explain when the treatment is expected to have an effect and the factors that may lead to adjustment of the treatment 
• Provide information regarding the (non-)administration of parenteral fluids (see the guideline Dehydration)

Communication 

• Ascertain whether the patient is experiencing anxiety, (existential) stress or other psychogenic factors 
• Discuss the change in role of nutrition and its importance in relation to the prognosis with the patient and his/her family and possible changes thereof.  
• Discuss the use and benefit of the ESAS. 

Supportive care 

• Ascertain whether advice from a dietician is needed to prevent unnecessary deterioration in nutritional status or to discuss the role of nutrition in relation to complaints 
• Discuss the influence of relaxation and distraction in situations in which anxiety plays a role. If required, contact a physiotherapist (for relaxation and massage), psychologist (relaxation, hypnosis, cognitive behavioural therapy for anticipatory nausea and vomiting), music therapist (relaxation and distraction), social worker (if there are financial or social issues) or spiritual care provider 
• Consider pharmacological support with anxiolytics for anxiety and stress 
• Consider engaging a volunteer in the terminal phase if the care threatens to become too much for the family. 

Continuity of care 

• Ensure multidisciplinary collaboration and effective patient transfer amongst care providers 
• Formulate and individual care plan