What influences attitudes towards clinically assisted hydration in the care of dying patients? A review of the literature.

BACKGROUND: An equivocal evidence base on the use of Clinically Assisted Hydration (CAH) in the last days of life presents a challenge for clinicians. In an attempt to provide clarity, the General Medical Council (GMC) has produced reasoned guidelines which identify that clinical vigilance is paramount, but that healthcare professionals should consider patient and family beliefs, values and wishes when making a decision to commence, withhold or withdraw CAH.

AIMS: To describe the attitudes and knowledge of patients, families, healthcare professionals and the general public regarding CAH in the care of dying patients.

METHODS: Four electronic databases were searched for empirical studies relating to attitudes and knowledge regarding CAH in the care of dying patients or end-of-life care (1985 and 2010). Selected studies were independently reviewed and data collaboratively synthesised into core themes.

RESULTS: From 202 identified articles, 18 papers met inclusion criteria. Three core themes emerged: (1) the symbolic value of hydration; (2) beliefs and misconceptions and (3) cultural, ethical and legal ideas about hydration.

CONCLUSIONS: Developing international evidence suggests that cultural norms and ethical principles of a family, population or healthcare environment influence attitudes towards CAH, particularly where CAH has symbolic meaning; representing care, hope and trust. However, there is surprisingly little robust evidence regarding dying patients, or the wider general public's views, on the perceived value of CAH in the last days and hours of life. Accordingly, a need for greater understanding of the perceptions regarding CAH, and their effects, is required.