Physician and Nurse Attitudes Toward Artificial Hydration for Terminally Ill Cancer Patients in Japan: Results of 2 Nationwide Surveys

Abstract

This study investigated physician and nurse attitudes toward artificial hydration in terminally ill cancer patients and compared differences in attitudes between these 2 professions and among clinical settings in Japan. The response rate was 53% (584/1123) for physicians and 79% for nurses (3328/4210). More physicians answered that artificial hydration alleviates the sensation of thirst. More palliative care unit physicians and nurses answered that withholding artificial hydration alleviated several physical symptoms. Oncologists answered that artificial hydration alleviated the sensation of thirst and fatigue. Discussion among patient-centered teams and individualized decision making are important. Because the differences identified here are attributable to differences in knowledge of artificial hydration for terminal cancer patients, oncologists should place greater emphasis on the opinion of palliative care specialists. Medical practitioners caring for terminal cancer patients should consider a broader range of views on hydration therapy, with a focus on effective hydration techniques and alternative interventions.

Keywords

palliative care fluid therapy attitude

Get full access to this article

View all access options for this article.

References

McCann RM , Hall WJ , Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. JAMA. 1994;272:1263-1266.

Viola RA , Wells GA , Peterson J. The effects of fluid status and fluid therapy on the dying: a systematic review . J Palliat Care. 1997;13:41-52.

Morita T. , Hyodo I. , Yoshimi T. , et al. Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol. 2005; 16:640-647.

Fainsinger RL , Bruera E.

When to treat dehydration in a terminally ill patient?

Support Care Cancer. 1997;5: 205-211.

Ripamonti C. , Twycross R. , Baines M. , et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer . Support Care Cancer. 2001;9:223-233.

Musgrave CF , Bartal N. , Opstad J. The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care. 1995;11:17-21.

Zerwekh JV The dehydration question. Nursing. 1983; 13:47-51.

Burge FI Dehydration symptoms of palliative care cancer patients. J Pain Symptom Manage. 1993;8:454-464.

Craig GM On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues. J Med Ethics. 1996;22:147-153.

10.

De Ridder D. , Gastmans C. Dehydration among terminally ill patients: an integrated ethical and practical approach for caregivers. Nurs Ethics. 1996 ;3:305-316.

11.

Chiu TY , Hu WY , Cheng SY , Chen CY Ethical dilemmas in palliative care: a study in Taiwan. J Med Ethics. 2000; 26:353-357.

12.

Morita T. , Shima Y. , Adachi I. ; Japan Palliative Oncology Study Group. Attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol. 2002;20:4699-4704.

13.

Morita T. , Shima Y. , Miyashita M. , Kimura R. , Adachi I. , Japan Palliative Oncology Study Group. Physician- and nurse-reported effects of artificial hydration therapy on symptoms of terminally ill patients with cancer. J Palliat Med. 2004;7:683-693.

14.

Parkash R. , Burge F. The family's perspective on issues of hydration in terminal care. J Palliat Care. 1997;13:23-27.

15.

Morita T. , Tsunoda J. , Inoue S. , Chihara S. Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care. 1999;16:509-516.

16.

Micetich KC , Steinecker PH , Thomasma DC

Are intravenous fluids morally required for a dying patient?

Arch Intern Med. 1983;143:975-978.

17.

Marin PP , Bayer AJ , Tomlinson A. , Pathy MS Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill. Postgrad Med J. 1989 ;65:650-652.

18.

Collaud T. , Rapin CH Dehydration in dying patients: study with physicians in French-speaking Switzerland . J Pain Symptom Manage. 1991;6:230-240.

19.

Bozzetti F. , Amadori D. , Bruera E. , et al. Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care. Nutrition. 1996;12:163-167.

20.

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;12:47-51.

21.

Meares CJ Primary caregiver perceptions of intake cessation in patients who are terminally ill. Oncol Nurs Forum. 1997;24:1751-1757.

22.

Cerchietti L. , Navigante A. , Sauri A. , Palazzo F. Hypodermoclysis for control of dehydration in terminal-stage cancer. Int J Palliat Nurs. 2000;6:370-374.

23.

Anonymous. Terminal dehydration. Lancet. 1986;1:306.

24.

Wanzer SH , Federman DD , Adelstein SJ , et al. The physician's responsibility toward hopelessly ill patients. A second look. N Engl J Med. 1989;320:844-849.

25.

Meares CJ Terminal dehydration: a review. Am J Hosp Palliat Care. 1994;11:10-14.

26.

Steiner N. , Bruera E. Methods of hydration in palliative care patients. J Palliat Care. 1998;14:6-13.