Author (year) | Aims | Participants | Setting | Method | Relevant findings |
---|---|---|---|---|---|
Chiu et al (2002)6 | To assess the inability to eat or drink in terminal cancer patients and to investigate the use of ANH | 196 doctors | Palliative care unit inpatients, Taiwan | Cross-sectional survey using assessment tool tested for content validity by panel of experienced specialists in the care of terminal cancer patients; piloted | Where healthcare professionals saw no medical indication for ANH it might be continued for moral/ethical reasons in accordance with family members’ wishes |
Ke et al (2008)7 | To understand the knowledge, attitudes and behavioural intentions of nurses providing ANH for terminal cancer patients | 197 nurses | Taiwan | Questionnaire tested by panel of experienced professionals using a content validity index | Limited knowledge about ANH for terminal cancer patients; believed to have more burdens than benefits, but behavioural intentions favoured providing ANH; provision associated with patient and family trust and avoiding patient abandonment |
Ke et al (2008)8 | To investigate the effects of an educational intervention on nurses’ knowledge, attitudes and behavioural intentions regarding supplying ANH to terminal cancer patients | 88 nurses (44 randomly assigned to educational intervention; 44 control) | Taiwan | Questionnaire tested by panel of expert professionals using a content validity index | Educational intervention regarding ANH improved nurses’ knowledge but did not have a statistically significant influence on behavioural intention; behavioural intention is thought to be influenced by food and family culture within Taiwanese society |
Marin et al (1989)9 | To investigate attitudes and practice of hospital doctors in the use of fluids and antibiotics for the terminally ill | 448 doctors | South Wales, UK | Non-validated questionnaire | Doctors provide CAH to ensure patient comfort |
McClement et al (2003)10 | To develop a conceptual model of family caregiver beliefs and behaviour related to nutritional care of the terminally ill | 13 cancer patients, 13 family members, 10 palliative care unit-bereaved family members, 11 palliative care professionals | Palliative care unit, Canada | Qualitative study; semistructures interviews; participant observation; grounded theory | Family members who ‘let nature take its course’ might still ask patients if they were hungry or thirsty, and would not refrain from assisting them to eat and drink, but were increasingly focused on other caregiving activities including mouthcare |
Mercadante et al (2005)11 | To evaluate patient and family perceptions about hydration | 54 cancer patients, 54 family members | Acute pain relief and palliative care unit, Italy | Non-validated questionnaire | Believed that CAH also provided nutrition; considered CAH useful psychologically |
Miyashita et al (2007)12 | To evaluate nurse views on decision-making discussion regarding CAH for terminally ill cancer patients | 3328 nurses | Japan | Questionnaire developed by the Japan Palliative Oncology Study group (J-POS); face validity confirmed by pilot test using 15 nurses from oncology and palliative care settings | Discussion of terminal hydration issues was insufficient; where disagreements about CAH arose, nurses experienced distress on behalf of patients and families |
Miyashita et al (2007)13 | To investigate physician and nurse attitudes toward CAH in terminally ill cancer patients | 584 doctors, 3328 nurses | Japan | Questionnaire developed by J-POS; face validity confirmed by pilot test with 11 physicians and 15 nurses from oncology and palliative care settings | Palliative care professionals believed that withholding CAH alleviated physical symptoms; physicians believed that CAH alleviated thirst; oncologists believed that CAH represented a minimum standard of care and alleviated fatigue, that its withdrawal shortens patient survival and leads to loss of trust; maintaining a venous route is a burden and patients have a right to refuse |
Morita et al (1999)14 | To clarify patients’ and family members’ perceptions about rehydration | 62 cancer patients, 119 family members | Hospice inpatients, Japan | Non-validated questionnaire | Patients could not get appropriate nutrition without CAH; withholding CAH would cause premature death; forced rehydration might worsen the patients’ suffering |
Morita et al (2002)15 | To clarify physician attitudes toward terminal dehydration | 584 doctors | Japan | Face validity of questionnaire confirmed by pilot test with 9 oncologists and 2 palliative care physicians | Physiological requirement, symptom palliation, minimum standard of care |
Morita et al (2004)16 | To clarify physician and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer | 413 oncologists, 88 palliative care physicians, 2735 oncology nurses, 593 palliative care nurses | Japan | Questionnaire developed by J-POS | Healthcare professionals frequently observed deterioration in fluid retention symptoms with limited benefits in alleviating dehydration symptoms |
Morita et al (2006)17 | To clarify the knowledge and beliefs of the general population about end-of-life care | 3061 general population subjects | Japan | Questionnaire content validity assessed by full agreement of the authors; piloted | CAH should be continued as the minimum standard until death; CAH relieves patient symptoms; no strong associations shown between experience of care in the last days of life and these beliefs |
Musgrave et al (1996)18 | To survey attitudes towards intravenous fluids in terminal cancer patients | 32 family members, 33 nurses | Oncology unit, Israel | Non-validated questionnaire | A generally positive attitude consistent with Jewish principle of sanctity of life; family members and nurses were not involved in decision making |
Parkash and Burge (1997)19 | To identify issues that are important to family caregivers when deciding whether or not CAH should be provided to patients with advanced cancer | Seven family members | Home support and inpatient divisions of a palliative care programme, Canada | Qualitative study; semistructured interviews | Some believed that CAH relieved suffering and preserved life, and CAH was associated with hope and care. Others thought CAH prolonged life at the expense of quality of life or an undignified death, and some cited the patient's wishes as their justification |
Pugh et al (2009)20 | To explore the belief system of healthcare professionals who care for individuals who are dying | 77 consultants, 24 nurse key workers | Acute hospital, UK | Non-validated questionnaire; piloted | In the questionnaire's hypothetical scenario, consultants were more likely than nurses to continue CAH |
Sanjo et al (2007)21 | To clarify end-of-life cancer care preferences and good death concepts | 2548 general population subjects, 513 palliative care unit-bereaved family members | Japan | Questionnaire face validity confirmed by pilot study | The general population believed that artificial hydration and nutrition should be continued as a minimum standard until death |
Van de Riet et al (2008)22 | To explore palliative care nurses’ and doctors’ perceptions and attitudes to patient nutrition and hydration at the end of life | 15 nurses, four doctors | An urban and rural palliative care service, Australia | Qualitative study; focus groups with nurses; single interviews with doctors; discourse analysis | Carers’ distress at the non-provision of CAH; CAH can be a symbol of comfort, care and hope; professionals’ position that dehydration lessens the burden of suffering for dying patients; polarisation between the acute and palliative care settings |
Yamagishi et al (2009)23 | To explore the effects of an interactive workshop based on a national guideline on the use of CAH for terminally ill cancer patients | 76 nurses | Japan | Non-validated questionnaire | The educational intervention improved nurses’ knowledge, confidence, and self-reported likeliness of practicing according to national guidelines |
ANH, artificial nutrition and hydration; CAH, clinically assisted hydration.