Patients' and Relatives' Perceptions About Intravenous and Subcutaneous Hydration

Abstract

Hydration during palliative care is a controversial topic. Most of the arguments are based on anedoctal reports that have not been substantiated with scientific data. Given that the choice is problematic from a clinical perspective, preferences of patients and family should dictate whether intravenous fluids are administered. The aim of this study was to evaluate patient and family perceptions about hydration and two modes of providing hydration. Fifty-four consecutive patients admitted to an acute pain relief and palliative care unit who required hydration completed a questionnaire regarding their perceptions on hydration and modes of hydration. Similarly, the principal family carer was chosen and similar questions were posed. For most items, patients and relatives agreed, considering hydration as a useful medical treatment that is able to provide some nutrition. The intravenous route was considered able to improve the clinical condition and to have a positive psychological meaning, representing an acceptable burden. The subcutaneous route was considered less effective, and not less bothersome than the intravenous route. Most patients and relatives agreed with continuing hydration at home, if necessary, preferring the intravenous route. Other than technical considerations, which can be variable according to the clinical setting, the perceived benefits of artificial hydration by the caregivers and patients are central to the ethical, emotional, and cultural considerations involved in their decision making. Most patients and relatives surveyed accepted and were in favor of intravenous hydration.

Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration

“…An Australian longitudinal, qualitative study exploring dying persons' and their caregivers' perspectives [11] has shown that patients experience a gradual decline in the need for oral intake rather than an abrupt cessation with little associated suffering while their caregivers report specific concerns about withdrawing ANH. (B) The large majority of data have been collected in Asian-Pacific patients [8]; the only European survey was done in Italy [18]. A strong belief in ANH benefits, both Responses to items PQ 9 (black) and RQ 9 (grey columns), pre-specified answer options.…”

Nutrition et hydratation en fin de vie : une mise en œuvre pas toujours bientraitante

“…». Savoir expliquer avec toute la mesure nécessaire qu'avec ou sans NHA il va mourir, mais que le maximum doit être fait pour assurer son confort, permet dans l'immense majorité des cas de répondre à la demande initiale [25,26]. Parfois, des convictions religieuses peuvent sous-tendre les demandes agressives de poursuivre « à tout prix » un support nutritionnel.…”

¿Es necesario hidratar artificialmente a los pacientes terminales?

“…Sin embargo, es importante recordar que, en algunas ocasiones, las personas enfrentadas al proceso de fi n de vida de un ser querido solicitan mantener la administración de fl uidos en estados terminales de inconsciencia o durante la agonía debido al alto valor simbólico que le atribuyen a la HA. Existen pocos estudios sobre la percepción de pacientes terminales y familiares de los benefi cios de la HA, pero se ha reportado que éstos la perciben como una manifestación de cuidado y -por tanto-como un bien que debe ser preservado hasta el fi nal [13][14][15] . …”