What Influences Patients’ Decisions on Artificial Hydration at the End of Life? A Q-Methodology Study

Abstract Context Artificial hydration (AH) is used to palliate patients with reduced fluid intake at the end of life but is a controversial practice. Patients’ involvement in decision making varies, and little is known about patients’ understanding of the benefits and burdens of AH. Objectives To id...

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Bibliographic Details
Published in:Journal of pain and symptom management 2011-08, Vol.42 (2), p.192-201
Main Authors: Malia, Catherine, MSc, Bennett, Michael I., MB, ChB, MD, FRCP
Format: Article
Language:English
Subjects:
Adult
Advance Directives
Aged
Aged, 80 and over
Anesthesia & Perioperative Care
Artificial hydration
Attitudes
Biological and medical sciences
Burden
Decision Making
End of life decisions
Female
Fluid Therapy
Humans
Hydration
Male
Medical sciences
Middle Aged
Pain Medicine
Palliative care
Pharmacology. Drug treatments
Q-Sort
Quality of Life - psychology
Surveys and Questionnaires
Terminal Care - psychology
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Summary:Abstract Context Artificial hydration (AH) is used to palliate patients with reduced fluid intake at the end of life but is a controversial practice. Patients’ involvement in decision making varies, and little is known about patients’ understanding of the benefits and burdens of AH. Objectives To identify the factors that patients consider most important when making decisions regarding AH at the end of life. Methods Interview study using Q-sort methodology conducted with 20 patients with advanced diseases recruited from inpatient and outpatient palliative care services. Results Several domains appear to influence a decision about AH: the patient’s understanding of AH, their philosophical position on end-of-life care, the process of discussion, and who makes the final decision. Patients generally based their decision on whether AH would improve quality of life, although prolonging life was important for some. Hydration was not considered a burden, and many would want a trial of AH in the event that they could no longer drink. Patients wanted to be guided by medical opinion, although some wanted to make the decision on their own. All patients welcomed the opportunity to discuss AH. Conclusion Patients view AH as an important issue and are keen to be involved in decision making. Health care professionals may withhold AH at the end of life because they perceive it as a burden on patients and on their interactions with family, although this view is not shared by patients. Some patients lack understanding regarding the likely benefits of AH. Research examining the impact of clinical information regarding AH on patients’ decision making is now needed.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2010.11.022