Background The impact of assisted hydration at the end of life is unclear and prevalence varies considerably worldwide. Little is known about optimal strategies for communicating and decision-making about this ethically complex topic. Hydration at the end of life is known to be an important topic for family members, but conversations about assisted hydration occur infrequently despite guidance suggesting that such conversations should occur with all dying people and those close to them.

Aim To explore doctors’ views and experiences of communicating and making decisions about assisted hydration at the end of life.

Design Semi-structured qualitative interview study with framework analysis.

Setting/participants Sixteen UK-based Geriatrics and Palliative Medicine doctors were recruited from a range of hospitals, hospices and community services, before and during the Covid-19 pandemic.

Results Participants reported clinical, practical and ethical challenges associated with this topic. The hospital setting provides several barriers to high-quality communication about assisted hydration at the end of life, 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. Exclusion of patients from decision-making about assisted hydration appears to be common practice.

Conclusions Proactive, routine discussion with dying people about issues relating to hydration 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.