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Medical communication and decision-making about assisted hydration in the last days of life: A qualitative study of doctors experienced with end of life care.

Published version
Peer-reviewed

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Type

Article

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Authors

Spathis, Anna 
Barclay, Stephen 

Abstract

BACKGROUND: The impact of assisted hydration on symptoms and survival at the end of life is unclear. Little is known about optimal strategies for communicating and decision-making about this ethically complex topic. Hydration near end of life is known to be an important topic for family members, but conversations about assisted hydration occur infrequently despite guidance suggesting these should occur with all dying people. AIM: To explore the views and experiences of doctors experienced in end-of-life care regarding communicating with patients and families and making decisions about assisted hydration at the end of life. DESIGN: Qualitative study involving framework analysis of data from semi-structured interviews. SETTING/PARTICIPANTS: Sixteen UK-based Geriatrics and Palliative Medicine doctors were recruited from hospitals, hospices and community services from October 2019 to October 2020. RESULTS: Participants reported clinical, practical and ethical challenges associated with this topic. The hospital setting provides barriers to high-quality communication with dying patients and their families about assisted hydration, which may contribute to the low incidence of documented assisted hydration-related conversations. Workplace culture in some hospices may make truly individualised decision-making about this topic more difficult. Lack of inclusion of patients in decision-making about assisted hydration appears to be common practice. CONCLUSIONS: Proactive, routine discussion with dying people about hydration-related issues is indicated in all cases. There is room for debate regarding the limits of shared decision-making and the benefits of routine discussion of assisted hydration with all dying people. Clinicians have to navigate multiple barriers as they strive to provide individualised care.

Description

Funder: NIHR Applied Research Collaboration East of England


Funder: Health Education East of England

Keywords

Decision making, communication, death, fluid therapy, shared, terminal care, Communication, Death, Decision Making, Hospice Care, Humans, Qualitative Research, Terminal Care

Journal Title

Palliat Med

Conference Name

Journal ISSN

0269-2163
1477-030X

Volume Title

36

Publisher

SAGE Publications