References

Chiu TY, Hu W-Y, Chuang R-B, Cheng Y-R, Chen C-Y, Wakai S. Terminal cancer patients' wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manage. 2004; 27:(3)206-214 https://doi.org/10.1016/j.jpainsymman.2003.12.009

Coelho TA, Wainstein AJA, Drummond-Lage AA-O. Hypodermoclysis as a strategy for patients with end-of-life cancer in home care settings. Am J Hosp Palliat Care. 2020; 37:(9)675-682 https://doi.org/10.1177/1049909119897401

Cohen MZ, Torres-Vigil I, Burbach BE, de la Rosa A, Bruera E. The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care. J Pain Symptom Manage. 2012; 43:(5)855-865 https://doi.org/10.1016/j.jpainsymman.2011.06.016

Dasgupta M, Binns M, Rochon PA. Subcutaneous fluid infusion in a long-term care setting. J Am Geriatr Soc. 2000; 48:(7)795-799 https://doi.org/10.1111/j.1532-5415.2000.tb04755.x

Davies AN, Waghorn M, Webber K, Johnsen S, Mendis J, Boyle J. A cluster randomised feasibility trial of clinically assisted hydration in cancer patients in the last days of life. Palliat Med. 2018; 32:(4)733-743 https://doi.org/10.1177/0269216317741572

Kingdon A, Spathis A, Brodrick R, Clarke G, Kuhn I, Barclay S. What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis. BMJ Support Palliat Care. 2021; 11:(1)68-74 https://doi.org/10.1136/bmjspcare-2020-002600

Lokker ME, van der Heide A, Oldenmenger WH, van der Rijt CCD, van Zuylen L. Hydration and symptoms in the last days of life. BMJ Support Palliat Care. 2019; https://doi.org/10.1136/bmjspcare-2018-001729

Mercadante S, Ferrera P, Girelli D Patients' and relatives' perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manage. 2005; 30:(4)354-358 https://doi.org/10.1016/j.jpainsymman.2005.04.004

Morita T, Miyashita M, Shibagaki M Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manage. 2006; 31:(4)306-316 https://doi.org/10.1016/j.jpainsymman.2005.09.004

Musgrave CF, Bartal N, Opstad J. Intravenous hydration for terminal patients: what are the attitudes of Israeli terminal patients, their families, and their health professionals?. J Pain Symptom Manage. 1996; 12:(1)47-51 https://doi.org/10.1016/0885-3924(96)00048-6

National Institute for Health and Care Excellence. Care of dying adults in the last days of life. 2013. https://tinyurl.com/f29zxkcw (accessed 18 May 2021)

NHS Benchmarking Network. National audit of care at the end of life: first round of audit report. 2019. https://tinyurl.com/jvkraph8 (accessed 20 May 2021)

O'Brien L. District nursing manual of clinical procedures.Chichester: John Wiley & Sons; 2012

O'Keeffe ST, Lavan JN. Subcutaneous fluids in elderly hospital patients with cognitive impairment. Gerontology. 1996; 42:(1)36-39 https://doi.org/10.1159/000213768

Pettifer A, Froggatt K, Hughes S. The experiences of family members witnessing the diminishing drinking of a dying relative: an adapted meta-narrative literature review. Palliat Med. 2019; 33:(9)1146-1157 https://doi.org/10.1177/0269216319859728

Raijmakers NJ L, van Zuylen L, Costantini M Artificial nutrition and hydration in the last week of life in cancer patients.:A systematic literature review of practices and effects. Ann Oncol. 2011a; 22:(7)1478-1486 https://doi.org/10.1093/annonc/mdq620

Raijmakers NJH, Fradsham S, van Zuylen L Variation in attitudes towards artificial hydration at the end of life: a systematic literature review. Curr Opin Support Palliat Care. 2011b; 5:(3)265-272 https://doi.org/10.1097/spc.0b013e3283492ae0

Raijmakers NJH, Clark JB, van Zuylen L, Allan SG, van der Heide A. Bereaved relatives' perspectives of the patient's oral intake towards the end of life: a qualitative study. Palliat Med. 2013; 27:(7)665-672 https://doi.org/10.1177/0269216313477178

Vidal M, Hui D, Williams J, Bruera E. A prospective study of hypodermoclysis performed by caregivers in the home setting. J Pain Symptom Manage. 2016; 25:(4)570-574 https://doi.org/10.1016/j.jpainsymman.2016.04.009

The known unknowns of assisted hydration at the end of life

02 June 2021
Volume 26 · Issue 6

Abstract

Much is unknown about assisted hydration at the end of life: why rates of usage vary so highly between institutions, cultures and countries, what beneficial or burdensome effects this treatment has, whether there is a place for subcutaneous hydration in the home setting, and how best to communicate about this difficult topic with dying people and their families. In light of a recently published systematic review concerning the impact of assisted hydration at the end of life, this article explores these questions and related issues, concluding that individualisation and shared decision-making are essential aspects of high-quality end-of-life care.

The use of assisted hydration (AH) at the end of life has long been the subject of controversy. Practice is highly varied between countries and cultures (Raijmakers et al, 2011a), and it may be that social and religious factors play a pivotal role. For example, beliefs about the sanctity of life in Orthodox Jewish or Catholic-majority countries, or about the importance of food and drink in some East Asian cultures, may increase the use of AH at the end of life (Musgrave et al, 1996; Chiu et al, 2004; Morita et al, 2006).

The frequency of provision of fluids for dying patients in a community setting is not known. A Dutch study (Lokker et al, 2019) demonstrated large differences in rates of administration of AH for patients in hospital and hospice (74% and 4%, respectively). What might explain these differences? AH may be considered conventional practice in hospital, or it may be provided because dying is not recognised promptly, or because conversations about stopping parenteral fluids are considered to be too difficult. In hospice settings, AH may be indicated on occasion, but may not be prescribed due to it not being perceived as standard practice.

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month