Variation in attitudes towards artificial hydration at the end of life

Raijmakers, Natasja; Fradsham, Sarah; Zuylen, Lia van; Mayland, Catriona; Ellershaw, John; Heide, Agnes van der

doi:10.1097/spc.0b013e3283492ae0

Cited by 28 publications

(6 citation statements)

References 25 publications

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“…There has been much controversy over hydration and its usefulness at the end of life; however, there is currently sufficient evidence to affirm that hydration does not have positive effects on the patient’s quality of life, nor does it prolong survival [14, 33–36]. …”

Section: Discussionmentioning

confidence: 99%

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

et al. 2016

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BackgroundMany ‘routine’ interventions performed in hospital rooms have repercussions for the comfort of the patient, and the decision to perform them should depend on whether the patient is identified as in a terminal phase. The aim of this study is to analyse the health interventions performed and decisions made in the last days of life in patients with advanced oncological and non-oncological illness to ascertain whether identifying the patient’s terminal illness situation has any effect on these decisions.MethodsRetrospective study of the clinical histories of deceased patients in four hospitals in Granada (Spain) in 2010. Clinical histories corresponding to the last three months of the patient’s life were reviewed.ResultsA total of 202 clinical histories were reviewed, 60 % of which were those of non-oncology patients. Opioid prescriptions (58.4 %), palliative sedation (35.1 %) and Do Not Resuscitate (DNR) orders (34.7 %) were the decisions most often reflected in the histories, and differences in these decisions were found between patients registered as terminal and those who were not registered as terminal. The most frequent interventions in the final 14 days and 48 h were parenteral hydration (96–83 %), peripheral venous catheter (90.1–82 %) and oxygen therapy (81.2–70.5 %). There were statistically significant differences between the patients who were registered as terminal and those not registered as terminal in the number of interventions applied in the final 14 days and 48 h (p = 0.01–p = 0.00) and in many of the described treatments.ConclusionThe recognition of a patient’s terminal status in the clinical history conditions the decisions that are made and is generally associated with a lower number of interventions.

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Section: Discussionmentioning

confidence: 99%

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

et al. 2016

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“…5 HCPs also report concern at the prospect of withholding CAH, 6 fearing the potential for dehydration to worsen symptoms including delirium, fatigue and thirst. 7 Conversely, routine provision of CAH in the last days of life is often not supported by HCPs experienced in providing endof-life care. CAH can be considered as hindering a 'natural' death, with hydration viewed as having the potential to increase nausea, dyspnoea, cough, respiratory secretions and the need to urinate.…”

Section: Introductionmentioning

confidence: 99%

“…CAH can be considered as hindering a 'natural' death, with hydration viewed as having the potential to increase nausea, dyspnoea, cough, respiratory secretions and the need to urinate. 7 No literature describes similar concerns from the public.…”

Section: Introductionmentioning

confidence: 99%

“…One review noted a broad range of 10%-88% of patients with cancer receiving CAH in the last week of life 8 ; in another, 22%-100% of HCPs preferred providing CAH at the end of Review life, whereas 1%-75% preferred not to. 7 Demonstrating the impact of cultural norms on practice in this field, a Dutch study found 74% of dying hospitalised patients received intravenous hydration, compared with 2% of dying hospice patients. 9 A Delphi study defining optimal palliative care in older people with dementia found high or very high consensus for 51 out of 57 domains but only moderate consensus around the statement 'Hydration… is inappropriate in the dying phase'.…”

Section: Introductionmentioning

confidence: 99%

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What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

Kingdon

Spathis

Brodrick

et al. 2020

BMJ Support Palliat Care

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BackgroundClinically assisted hydration (CAH) can be provided in the last days of life as drinking declines. The impact of this practice on quality of life or survival in the last days of life is unclear. Practice varies worldwide concerning this emotive issue.MethodSystematic literature review and narrative synthesis of studies evaluating the impact of, or attitudes toward, CAH in the last days of life. Databases were searched up to December 2019. Studies were included if the majority of participants were in the last 7 days of life, and were evaluated using Gough’s 'Weight of Evidence' framework. Review protocol registered with PROSPERO, registration number CRD42019125837.ResultsFifteen studies were included in the synthesis. None were judged to be both of high quality and relevance. No evidence was found that the provision of CAH has an impact on symptoms or survival. Patient and family carer attitudes toward assisted hydration were diverse.ConclusionThere is currently insufficient evidence to draw firm conclusions on the impact of CAH in the last days of life. Future research needs to focus on patients specifically in the last days of life, include those with non-malignant diagnoses, and evaluate best ways to communicate effectively about this complex topic with patients and their families.

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“…[37,38] As Koretz nicely stated, patients and families often worry about “starving to death” and frequently get confused “between dying in a malnourished state and dying as a direct consequence of nutrient deprivation; cancer patients fit into the former category.”[39] An interdisciplinary team consisting of physicians, nurses, psychologists, speech pathologists, physical/occupational therapists and dieticians can provide appropriate education, gentle reassurance, emotional support and nutritional guidance for patients in the last days and their families: Clinicians should have honest discussions with patients and families about prognosis and goals of care.In the last days of life, patients often have symptoms that prevent them to eat/drink properly (e.g. dysphagia) and do not desire eating.…”

Section: Approach To Hydration and Nutrition In The Last Days Of Lifementioning

confidence: 99%

The last days of life

Hui

Dev

Bruera

2015

Current Opinion in Supportive &Amp; Palliative Care

101

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Purpose of review We will review the symptom burden in cancer patients in the last days of life, its impact on nutrition and hydration, and the role of artificial nutrition and hydration in patients with days of life expectancy. Recent findings In the last days of life, cancer patients often experience progressive functional decline and worsening symptom burden. Many symptoms such as anorexia-cachexia, dysphagia and delirium could impair oral intake. These, coupled with refractory cachexia, contribute to persistent weight loss and decreased quality of life. Furthermore, the inability to eat/drink and body image changes can result in emotional distress for patients and caregivers. Clinicians caring for these individuals need to ensure longitudinal communication about goals of care, education about the natural process of dying, optimization of symptom management, and provide appropriate emotional support for patients and caregivers. There is a lack of evidence to support that artificial nutrition and hydration can improve outcomes in the last days of life. Artificial nutrition is not recommended because of its invasive nature, while artificial hydration may be considered on a case-by-case basis. Summary This review highlights the need to conduct further research on symptom burden, nutrition and hydration in the last days of life.

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Variation in attitudes towards artificial hydration at the end of life

Abstract: Opinions and attitudes towards the use of artificial hydration at the end of life vary. Communication of this imperative topic in end-of-life care is important for better care and should be research-based.

Cited by 28 publications

References 25 publications

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

Interventions and decision-making at the end of life: the effect of establishing the terminal illness situation

What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

The last days of life

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