**2. Methods**

This was a cross-sectional and observational study based on a qualitative approach, which was approved by the local Ethics Committee under protocol number 2.925.747/2018. The study was carried out in the steps that follow: 1) The physicians included were approached individually and informed about the objective and methodology of the study. Those who agreed to participate signed written informed consent; 2) After that, each doctor received by e-mail, through google.docs, a clinical case involving a hypothetical patient with advanced dementia, who was not a candidate for disease-modifying therapy, admitted to the hospital with a respiratory infection secondary to bronchoaspiration, and with subsequent evolution involving end of life signs (**Table 1**); 3) Doctors had to analyzed the clinical case and then they had to answer a single question about which nutritional option would be the most suitable in that clinical situation.

Discursive responses were collected between December 2018 and March 2019 and confindentiality was guaranteed throughout the Project. The authors used the SRQR checklist when writing our report as a requirement for qualitative studies [13].

M.A.S.S., 86 years old, female, admitted in the emergency with productive cough (hyaline expectoration) and report of the caregiver of post-eating gags. The caregiver is her only child, 62 years old, no children, single, exclusive caregiver of the mother in the last 3 years when she had to abandon her job to dedicate herself to her mother exclusively.

Vital signs: PA = 90 x40mmHg; FC = 104 bpm; FR = 20irpm; SatO2 = 96% (in ambient air); TAX = 36.7°C.

In view of the hypothesis of pneumonia secondary to bronchoaspiration, hospital admission was requested. Physician that receives the patient and after initial clinical measures (oxygen therapy and nebulization) the patient stay stable.

Morbid-personal antecedents: Patient with elderly's fragility syndrome and Alzheimer's dementia for about 3 years and, for about 1 year, totally dependent on basic daily activities (bathing, clothing, transference, continence, hygiene). She has been enrolled for a year with recurrent infections (pneumonia and urinary tract infection).

Already accompanied by a multidisciplinar team of palliative care since the diagnosis of dementia. She has been attending a low oral intake and coughing after feeding for 6 mouths and 1 month ago, had been treated for pneumonia with oral antibiotic. No pain or other symptoms.

Medications on use: Donepezil 10 mg/day; Lactulose 10 ml 12/12 hours.

Significant findings on physical examination: Sarcopenia, spontaneous ocular opening but not contacting, snoring transmission on the pulmonary auscultation.

In view of the clinical case presented, in the current hospitalization, we would like to know what you would be conduct in relation to food. Would you recommend the beggining of artificial diet? Justify your answer.

**Table 1.**

*Clinical case.*
