Pleasure in Eating at the End of Life

eating well cookbook cover

Pleasure in Eating at the End of Life

In 2018, Dr. Bernard Lapointe (previous Kappy and Eric M. Flanders Chair of Palliative Care McGill and long-time Chair of the McGill International PC Congress) went to the Institute du Tourisme et de l’Hotellerie du Quebec (ITHQ) to inquire whether they were interested in embarking on a project to foster the pleasure of eating at the end of life. Dr Alan Girard [Professeurs-chercheurs - Institut de tourisme et d'hôtellerie du Québec (ithq.qc.ca)], trained sociologist and previous Coordinator of University Programs from 2014 to 2017 at ITHQ and researcher since 2017, took up the challenge. They both strongly believe that it is not only possible but imperative to offer delicious food adapted to those at the end-of-life.Alain Girard

Suzanne LeBlanc (SL): Tell us about the circumstances surrounding the publication of these specialized cookbooks?

Alain Girard (AG): The publication of the first edition took place in 2018 following our collaboration with Dr. Bernard Lapointe [Manger dans la dignité, ou l’importance de la nourriture en fin de vie | Mordu (radio-canada.ca) ] This collaboration resulted in a course at the Restaurant Management level at ITHQ. My contribution, at the beginning, was doing formal research on the pleasure of eating and initiatives in palliative care globally. I was also member of the jury for about fifteen recipes.

This cookbook was originally published in time for the McGill International Palliative Care Congress in 2018. We held a panel discussion in the main conference hall to discuss this project and the pleasure of eating at the end of life with hundreds of people present. Our students gave cooking demonstrations of two recipes each and the head chef was present to explain the teaching methods. This exercise resulted in a dozen new recipes hence the 2nd edition of the cookbook in 2019. This year, we are planning on publishing six new recipes, so overall, we will have 26 recipes in a new edition. We are hoping that the next edition will be published in time for McGill International Palliative Care Congress in 2024 [News & Events | Palliative Care McGill - McGill University]. If we had some funds from a foundation for this new edition, it would be amazing to continue even further with this pioneering work!

(SL): How many years has the ITHQ included the teaching of adapted recipes for people at the end of life?

Alain Gerard (AG): Several years now. This course is not compulsory but rather, takes place in the framework of ad hoc projects. In the final year at ITHQ students in Restaurant Management are introduced to the art of texturing. We ask them to do a research and development project which aims to develop and cook cafeteria meals adapted to this clientele. Even if it is not compulsory in the program, it is nevertheless integrated into the course with the collaboration of the teacher.

(SL): Do some students choose to work in palliative care institutions as a result of their training in recipe adaptation?

(AG): At the beginning, some students are curious, others less so. Once they have had the training, the students can get involved in this milieu. Typically, students do not think about old age, end of life and death at this young stage of their lives. However, students do associate these issues with their loved ones who have had incurable diseases and through these experiences, better understand the context. In Restaurant Management, graduates find themselves working mainly in food services which is the biggest sector in food management in Quebec. Food services include cafeterias in Old Age Residences (OAR), long-term care facilities (CHSLD), secondary schools, universities and corporations.

(SL): What is the aim of these cookbooks?

(AG): Our cookbooks are meant for single portions for kitchens in small palliative centres or at home. Indeed, this is the gesture that most matters, giving pleasure in eating.

Nevertheless, it is necessary to have training in management and professional cooking to standardize the recipes in order to serve fifty or more patients if required. It is important that the food is appropriately textured, attractive and delicious.

(SL): What is food texturing? This seems like an important concept.

(AG): In technical terms, the texture of food is an organoleptic quality that can be defined as the “sensitive and functional manifestation of structural and mechanical properties of food detected by senses of vision, hearing, touch and smell”.

In layman terms, it means the transformation of food into purees, gelatines or foams in order to preserve their taste while remaining attractive. This is achieved through special techniques developed in the kitchen. In the dishes adapted for this clientele, it is important to separate the different foods, the colours, cubing the meats and gelling them, colouring certain meats with beets, making an emulsion of fine herbs, with the aim of making the food appealing to the eye. This allows the patient with dysphagia, loss of appetite and dry mouth, to eat without the risk of choking.

(SL): Are you continuing to collaborate with Dr. Bernard Lapointe?

(AG): This is an ongoing project. In 2022, Dr. Lapointe was part of the jury at ITHQ; he tasted all the dishes with us and provided feedback. And recently in 2023, he was a jury member for our latest adapted dishes. He continues to have an influence at the scientific and research level and his achievements have had an impact on the quality of care provided to patients dealing with an incurable disease or at the end of life, and in how we prepare food. For my part, I continue to promote and develop the adaptation of food for the pleasure of eating for people at the end of life. The ITHQ continues to train cooking students on the art and science of adapting recipes for the end of life.

Note: Dr Bernard Lapointe was nominated Officer of the Order of Canada in 2022 for his lifetime achievements in the field of palliative care [Council on Palliative Care and Palliative Care McGill Newsletter (envoke.com)]. Recently, in an interview on CBC [Palliative care physician Dr. Bernard Lapointe appointed to the Order of Canada | Let's Go with Sabrina Marandola | Live Radio | CBC Listen],he says how proud he is of the collaboration with the ITHQ in developing a new way of cooking (with smaller portions and modified consistency) which allows people who have difficulty swallowing to enjoy food.

To download the recipes books, Eating Well Always [In English and French), go to: Recipe Book | Palliative Care McGill - McGill University.

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