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Friedrichsen M, Lythell C, Milovanovic M, Waldréus N, Thulesius H, Jaarsma T, Jaarsma P, Hedman C, Schaller AS. Nurses' experiences of ethical challenges concerning thirst in dying patients in specialist palliative care: a qualitative study. BMC Palliat Care 2024; 23:192. [PMID: 39080626 PMCID: PMC11290186 DOI: 10.1186/s12904-024-01519-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024] Open
Abstract
AIM To describe nurses' experiences of ethical challenges in relation to thirst in terminally ill patients in specialist palliative care units. RESEARCH DESIGN A qualitative, reflexive thematic design with an inductive analysis was used. PARTICIPANTS AND RESEARCH CONTEXT Eighteen qualitative interviews with nurses working in six different specialist palliative care units in different hospitals in Sweden were conducted. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. RESULTS This study identified four themes that reflect ethical challenges experienced by nurses in the palliative care regarding thirst: Harmful infusions interfere with peaceful dying; conflict between tradition and personal experience; What is the right intervention to quench thirst? and; Lack of standard procedures, competence and interest among team members. CONCLUSION Palliative care nurses experience a number ethical challenges in relation to thirst in dying patients. The main challenge is the provision of fluids to dying patients via artificial infusions, which nurses struggle with, as they do not want to interfere with a peaceful dying process.
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Affiliation(s)
- Maria Friedrichsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden.
| | - Caroline Lythell
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Vrinnevi hospital, Norrköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Theme Inflammation and Aging, Karolinska Institutet, Karolinska University Hospital, Huddinge, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Hans Thulesius
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Region Kronoberg, Kalmar, Växjö, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pier Jaarsma
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Imanaga T. Use of artificial hydration in patients diagnosed with senility as the cause of death by home care physicians: A cross₋sectional study. J Gen Fam Med 2024; 25:121-127. [PMID: 38707703 PMCID: PMC11065145 DOI: 10.1002/jgf2.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/11/2024] [Accepted: 02/19/2024] [Indexed: 05/07/2024] Open
Abstract
Background The aim of this study was to investigate the frequency, effectiveness, and reasons for the use of artificial hydration (AH) in senile patients in the last week, and patient-related factors associated with its usage. Methods Between April and May 2023, I conducted a cross₋sectional study among medical institutions affiliated with the Japan Network of Home Care Supporting Clinics. Eligible cases included those in which senility was listed as the cause of death on the death certificate from January 1, 2022, to December 31, 2022. The questions asked use of AH, reasons for AH, and symptoms that improved or worsened with AH. Patient characteristics, including age, gender, place of death, length of treatment, and complication of dementia, were also asked. Descriptive statistics were performed. Univariate and multivariate analyses were conducted to examine the association between patient characteristics and the use of AH. Results Eighty-three medical institutions (12.5%) provided responses, contributing a total of 714 cases. AH was administered in 236 cases (33.1%). The most common reason was "due to family preference" in 110 cases (46.6%). One hundred thirty-five cases (57.2%) reported "no improved symptoms," while symptom worsening was reported as "no worsened symptoms" in 176 cases (74.6%). Multivariate analysis on 699 cases using complete-case analysis identified age (risk ratio [RR]:0.98, 95% confidence interval [CI]: 0.96-0.99) and female (RR:0.73, 95% CI:0.58-0.92) as factors associated with the use of AH. Conclusion This study revealed that AH was commonly used based on family preferences and to alleviate psychological burdens on the family.
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Buchan EJ, Haywood A, Syrmis W, Good P. Medically assisted hydration for adults receiving palliative care. Cochrane Database Syst Rev 2023; 12:CD006273. [PMID: 38095590 PMCID: PMC10720602 DOI: 10.1002/14651858.cd006273.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Many people receiving palliative care have reduced oral intake during their illness, and particularly at the end of their life. Management of this can include the provision of medically assisted hydration (MAH) with the aim of improving their quality of life (QoL), prolonging their life, or both. This is an updated version of the original Cochrane Review published in Issue 2, 2008, and updated in February 2011 and March 2014. OBJECTIVES To determine the effectiveness of MAH compared with placebo and standard care, in adults receiving palliative care on their QoL and survival, and to assess for potential adverse events. SEARCH METHODS We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, CANCERLIT, CareSearch, Dissertation Abstracts, Science Citation Index and the reference lists of all eligible studies, key textbooks, and previous systematic reviews. The date of the latest search conducted on CENTRAL, MEDLINE, and Embase was 17 November 2022. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) of studies of MAH in adults receiving palliative care aged 18 and above. The criteria for inclusion was the comparison of MAH to placebo or standard care. DATA COLLECTION AND ANALYSIS Three review authors independently reviewed titles and abstracts for relevance, and two review authors extracted data and performed risk of bias assessment. The primary outcome was QoL using validated scales; secondary outcomes were survival and adverse events. For continuous outcomes, we measured the arithmetic mean and standard deviation (SD), and reported the mean difference (MD) with 95% confidence interval (CI) between groups. For dichotomous outcomes, we estimated and compared the risk ratio (RR) with 95% CIs between groups. For time-to-event data, we planned to calculate the survival time from the date of randomisation and to estimate and express the intervention effect as the hazard ratio (HR). We assessed the certainty of evidence using GRADE and created two summary of findings tables. MAIN RESULTS: We identified one new study (200 participants), for a total of four studies included in this update (422 participants). All participants had a diagnosis of advanced cancer. With the exception of 29 participants who had a haematological malignancy, all others were solid organ cancers. Two studies each compared MAH to placebo and standard care. There were too few included studies to evaluate different subgroups, such as type of participant, intervention, timing of intervention, and study site. We considered one study to be at high risk of performance and detection bias due to lack of blinding; otherwise, risk of bias was assessed as low or unclear. MAH compared with placebo Quality of life One study measured change in QoL at one week using Functional Assessment of Cancer Therapy - General (FACT-G) (scale from 0 to 108; higher score = better QoL). No data were available from the other study. We are uncertain whether MAH improves QoL (MD 4.10, 95% CI -1.63 to 9.83; 1 study, 93 participants, very low-certainty evidence). Survival One study reported on survival from study enrolment to last date of follow-up or death. We were unable to estimate HR. No data were available from the other study. We are uncertain whether MAH improves survival (1 study, 93 participants, very low-certainty evidence). Adverse events One study reported on intensity of adverse events at two days using a numeric rating scale (scale from 0 to 10; lower score = less toxicity). No data were available from the other study. We are uncertain whether MAH leads to adverse events (injection site pain: MD 0.35, 95% CI -1.19 to 1.89; injection site swelling MD -0.59, 95% CI -1.40 to 0.22; 1 study, 49 participants, very low-certainty evidence). MAH compared with standard care Quality of life No data were available for QoL. Survival One study measured survival from randomisation to last date of follow-up at 14 days or death. No data were available from the other study. We are uncertain whether MAH improves survival (HR 0.36, 95% CI 0.22 to 0.59; 1 study, 200 participants, very low-certainty evidence). Adverse events Two studies measured adverse events at follow-up (range 2 to 14 days). We are uncertain whether MAH leads to adverse events (RR 11.62, 95% CI 1.62 to 83.41; 2 studies, 242 participants, very low-certainty evidence). AUTHORS' CONCLUSIONS: Since the previous update of this review, we have found one new study. In adults receiving palliative care in the end stage of their illness, there remains insufficient evidence to determine whether MAH improves QoL or prolongs survival, compared with placebo or standard care. Given that all participants were inpatients with advanced cancer at end of life, our findings are not transferable to adults receiving palliative care in other settings, for non-cancer, dementia or neurodegenerative diseases, or for those with an extended prognosis. Clinicians will need to make decisions based on the perceived benefits and harms of MAH for each individual's circumstances, without the benefit of high-quality evidence to guide them.
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Affiliation(s)
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
| | - William Syrmis
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia
| | - Phillip Good
- Mater Research Institute - The University of Queensland, Brisbane, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Australia
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Friedrichsen M, Lythell C, Jaarsma T, Jaarsma P, Ångström H, Milovanovic M, Karlsson M, Milberg A, Thulesius H, Hedman C, Waldréus N, Söderlund Schaller A. Thirst or dry mouth in dying patients?-A qualitative study of palliative care physicians' experiences. PLoS One 2023; 18:e0290075. [PMID: 37585424 PMCID: PMC10431603 DOI: 10.1371/journal.pone.0290075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Thirst and dry mouth are common symptoms among patients at the end of life. In palliative care today, there is a focus on mouth care to alleviate thirst. There are no qualitative studies on thirst from a physician's experience, which is why this study is needed. PURPOSE This study aimed to explore palliative care physicians' experiences and views of thirst in patients at the end of life. METHODS A qualitative interview study with an inductive approach was carried out. Sixteen physicians working in specialised palliative care units in Sweden were included. The interviews were analysed with a reflexive thematic analysis. RESULTS The analysis resulted in three basic assumptions regarding thirst: It is dry mouth, not thirst; patients are dry in their mouth and thirsty; and, I do not know if they are thirsty. Further, four different themes regarding how to relieve thirst appeared: drips will not help thirst but cause harm; the body takes care of thirst itself; drips might help thirst; and, mouth care to relieve thirst or dry mouth. CONCLUSIONS The palliative care physicians had different experiences regarding thirst, from thirst never arising, to a lack of awareness. They thought good mouth care worked well to alleviate the feeling of thirst and dry mouth. Most physicians did not want to give patients drips, while some did. This study indicates that there are many unanswered questions when it comes to thirst at end-of-life and that further research is needed.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Caroline Lythell
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pier Jaarsma
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helene Ångström
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Vrinnevi Hospital, Norrköping, Sweden
| | - Marit Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Palliative Education and Research Centre, Vrinnevi Hospital, Norrköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Thulesius
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Region Kronoberg, Växjö, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Anne Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Centre, Linköping, Sweden
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Friedrichsen M, Lythell C, Waldréus N, Jaarsma T, Ångström H, Milovanovic M, Karlsson M, Milberg A, Thulesius H, Hedman C, Schaller AS, Jaarsma P. Ethical challenges around thirst in end-of-life care -experiences of palliative care physicians. BMC Med Ethics 2023; 24:61. [PMID: 37559116 PMCID: PMC10413708 DOI: 10.1186/s12910-023-00943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Thirst and dry mouth are common symptoms in terminally ill patients. In their day-to-day practice, palliative care physicians regularly encounter ethical dilemmas, especially regarding artificial hydration. Few studies have focused on thirst and the ethical dilemmas palliative care physicians encounter in relation to this, leading to a knowledge gap in this area. AIM The aim of this study was to explore palliative care physicians' experiences of ethical challenges in relation to thirst in terminally ill patients. METHODS A qualitative interview study with an inductive approach was conducted. Sixteen physicians working in four different specialised palliative care units and one geriatric care unit in different hospitals in Sweden were interviewed. The interviews were transcribed verbatim and analysed with a reflexive thematic analysis. RESULTS When presented with an ethical challenge relating to thirst, physicians attempted to balance benefits and harms while emphasizing respect for the patient's autonomy. The ethical challenges in this study were: Starting, continuing or discontinuing drips; lack of evidence and traditions create doubt; and lack of interest and time may result in patient suffering. CONCLUSIONS All physicians in this study reported that "Starting, continuing or discontinuing drips" was the main ethical challenge they encountered, where some were so accustomed to the decision that they had a standard answer ready to offer patients and families. Physicians reported that drips were a symbol of thirst quenching, life and survival but were not necessary in end-of-life care. Others questioned the traditions regarding thirst and emphasised drips in particular.
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Affiliation(s)
- Maria Friedrichsen
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Caroline Lythell
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Nana Waldréus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Helene Ångström
- Palliative Education and Research Centre, Vrinnevi hospital, Norrköping, Sweden
| | - Micha Milovanovic
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Internal Medicine, Vrinnevi hospital, Norrköping, Sweden
| | - Marit Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Thulesius
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden and Region Kronoberg, Växjö, Sweden
| | - Christel Hedman
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne Söderlund Schaller
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pier Jaarsma
- Division of Society and Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Donati E, Plotton C, Mainaud N, Gocko X. Arrêt de l’hydratation artificielle chez les patients en fin de vie : une revue systématique de la littérature. Bull Cancer 2022; 109:1073-1081. [DOI: 10.1016/j.bulcan.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/22/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022]
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Kvalheim SF, Strand GV. A Narrative of Oral Care in Palliative Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106306. [PMID: 35627842 PMCID: PMC9141643 DOI: 10.3390/ijerph19106306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
Painful oral conditions represent a significant problem for most patients with a serious disease and palliative care needs. The main causes of such conditions may be associated with the underlying disease and its treatment, but primarily with adverse side effects of drugs. Oral conditions can lead to worsening of the illness and reduced quality of life. The objective of this narrative is to present an overview of oral care problems of this group, including present clinical practice. The evidence base for procedures and efficient products is weak. There is therefore an obvious need for research within this field.
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Shih YA, Wang C, Jin S, Feng W, Lu Q. Decision Making of Artificial Nutrition and Hydration for Cancer Patients at Terminal Stage-A Systematic Review of the Views From Patients, Families, and Healthcare Professionals. J Pain Symptom Manage 2021; 62:1065-1078. [PMID: 33933623 DOI: 10.1016/j.jpainsymman.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Decision making on nutrition and hydration for cancer patients during terminal stage cause critical impacts toward patient's comfort and living quality. The management of nutrition is the main dilemma that arises in these final situations and has been the subject of intense debate over the last few decades. AIM To find the views of patients, families, and healthcare professionals related to how decisions are made when cancer patients are at terminal stage. DESIGN This systematic review used PRISMA strategy to search and used Critical Appraisal Skills Programme checklist to evaluate the papers. DATA SOURCES All English papers through August 2020 that contained the view of the decision making at artificial nutrition and hydration with cancer patients, families, and healthcare professionals at terminal stage were included. Selected studies were independently reviewed, and data collaboratively synthesized into core themes. RESULTS Most of the terminal stage cancer patients and their families initially started the decision-making process when facing the reduction of oral intake. There are two primary considerations of patients and families, one is for prolonging patients life, and the other is to maintain their life quality. The voices of patients were influential, but not determinative; families usually had influence, but seldom make the final recommendation by themselves; healthcare professionals frequently face the dilemma about their decision. CONCLUSION The decision of nutritional support was dynamic; the interaction between patients and families frequently be hesitated to protect the rights of life, unnecessarily prolonging lifetime. Therefore, a better understanding of the views on nutritional support and processing the clinical guideline of decision making for healthcare professional is necessary.
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Affiliation(s)
- Yi An Shih
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China
| | - Cheng Wang
- Peking Union Medical College, Tsinghua University (C.W.)
| | - Sanli Jin
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China
| | - Wen Feng
- School of Public Health, Peking University Health Science Center (W.F.), Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China.
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Strang P, Martinsson L, Bergström J, Lundström S. COVID-19: Symptoms in Dying Residents of Nursing Homes and in Those Admitted to Hospitals. J Palliat Med 2021; 24:1067-1071. [PMID: 33667124 DOI: 10.1089/jpm.2020.0688] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: To compare symptom prevalence and relief in residents who died in nursing homes with residents who were acutely referred to hospitals. Design: Data on symptoms during the last week of life from the Swedish Register of Palliative Care (SRPC). Setting and Subjects: Nursing homes (n = 1903 deaths) and hospitals in Sweden (n = 202 nursing home residents who were admitted to hospital before death). Data were retrieved on August 24, 2020. Results: Residents who died in hospitals had more breakthrough symptoms of breathlessness (60% vs. 31%, p < 0.0001) and delirium (41% vs. 25%, p < 0.0001) than those who died in nursing homes. When symptoms were present, complete symptom relief was seen less often in hospitals compared with nursing homes (breathlessness, 28% vs. 47%, p < 0.001; delirium, 10% vs. 35%, p < 0.0001; respiratory secretions, 30% vs. 55%, p < 0.0001). Conclusion: Despite access to oxygen and pharmacologic/nonpharmacologic therapies in hospitals, symptom relief in dying nursing home residents acutely admitted to hospitals was lower compared with those who died in nursing homes, possibly because of differences in patient characteristics.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Stockholm and R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Lisa Martinsson
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Jonas Bergström
- Palliative Care Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Staffan Lundström
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Stockholm and R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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The why and how of maintaining hydration during cancer therapy. Curr Opin Support Palliat Care 2020; 14:324-332. [PMID: 33009008 DOI: 10.1097/spc.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of the role hydration plays in the oncology population while providing a synopsis of recent scientifically relevant published practice advancements. RECENT FINDINGS Dehydration causes substantial symptom burden in cancer patients, secondary to both disease process and treatment complications. Maintaining fluid and electrolytes balance is the key to hydration therapy. When oral intake is diminished, artificial hydration can be delivered via enteral, intravenous and subcutaneous routes. Use of artificial hydration in end-of-life care for cancer patients remains a highly debated topic with unclear benefits and lack of established standards. A holistic approach is required in the decision-making process. SUMMARY Maintaining adequate hydration is important in patients receiving cancer therapy. Challenges exist, secondary to limited clinical guidelines of hydration in patients with advanced cancer. Artificial hydration may be indicated for selected patients at the end of life if used on an individualized basis as medical treatment.
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