Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around "terminal anorexia nervosa" underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical "Top Ten Tips" framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians' confidence and consistency when caring for patients with severe EDs.
Robbins-Welty et al. (Mon,) studied this question.