Intravenous hydration for terminal patients: What are the attitudes of Israeli terminal patients, their families, and their health professionals?

Abstract

Dehydration in terminally ill patients is a common condition and its treatment in an active oncology unit often involves intravenous (IV) hydration programs. The decision to use IV hydration is only partly determined by an objective assessment of the clinical data. The other component is the attitudes of those involved in the decision-making process. This pilot study surveyed the attitudes of patients, family members/friends, nurses and doctors toward IV hydration in this patient population. Although the majority of the conscious patients (95%), family members/friends (81%), and nurses (64%) were not involved in the decision-making process, the expressed attitudes were generally positive. The three most commonly stated reasons for IV therapy were "medication," "giving fluids" and "giving morphine." Interestingly, among the reasons expressed, the amelioration of thirst was never explicitly cited.

Effects of educational intervention on nurses’ knowledge, attitudes, and behavioral intentions toward supplying artificial nutrition and hydration to terminal cancer patients

“…This is similar with Japan, which also shares the oriental culture where families participate in more than 90% of the decision making regarding administering ANH to terminal cancer patients [22]. It is different from the study of Israeli where family's involvement in decision-making process to intravenous therapy is only 13% [24]. This demonstrates the strong influence of families in the medical decision process for terminal cancer patients in oriental culture.…”

What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature

“…In Israel, attitudes are generally positive and thought to accord with Jewish culture which prioritises the principle of sanctity of life, where every effort should be made to prolong life 18. In East Asia, the phrase ‘minimum standard of care’ was deemed to be culturally significant and a subject of questionnaires to which physicians and the general population responded favourably 13 15.…”

¿Es necesario hidratar artificialmente a los pacientes terminales?

“…Además de la falta de estándares clínicos que orienten su uso, las opiniones sobre su indicación pueden ser muy diferentes al interior del equipo de salud, especialmente entre médicos y enfermeras, lo que puede generar confl ictos e importante estrés en relación al cuidado de estos pacientes [28][29] . La opinión de pacientes y familiares en relación a este tema ha sido escasamente investigada, sin embargo, algunos estudios han mostrado que frecuentemente pacientes/familiares no son incluidos en la toma de decisiones [29][30] , lo que contrasta con evidencia que muestra que el impacto emocional que tienen los síntomas en familiares de pacientes en fi n de vida es enorme, particularmente cuando el estado cognitivo de los pacientes está alterado 31,32 . Además, nos parece importante recalcar la importancia de considerar el profundo valor simbólico que algunas personas atribuyen al uso de HA entre los cuidados que se otorgan a los pacientes al fi nal de ¿Es necesario hidratar artificialmente a los pacientes terminales?…”