Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Supportive Care in Cancer
Published in: Supportive Care in Cancer 12/2014

01-12-2014 | Original Article

Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration

Authors: J. Bükki, T. Unterpaul, G. Nübling, R. J. Jox, S. Lorenzl

Published in: Supportive Care in Cancer | Issue 12/2014

Login to get access

Abstract

Purpose

Deciding on artificial nutrition and hydration (ANH) at the end of life (EoL) may cause concerns in patients and their family caregivers but there is scarce evidence regarding their preferences. Therefore, the aim of this study was to assess the impact of factors associated with ANH decision making.

Methods:

Prospective, Cross-sectional survey. Adult patients admitted to hospital for symptoms of advanced cancer as well as their family caregivers completed a self-administered questionnaire. Items included personal views and concerns about ANH. Family caregivers additionally recorded their preference for their loved one and, if applicable, previous experience with ANH decisions.

Results

Thirty-nine out of sixty-five patients and 30/72 relatives responded. Higher age of the patient was significantly correlated with both the patient’s and the relative’s decision to forgo ANH (Kruskal-Wallis test, p < 0.01). Thirty-nine percent of patients, 37 % of relatives if deciding for themselves, and 24 % of relatives if deciding on behalf of their loved one opted against ANH; 36, 40 and 52 % preferred artificial hydration (AH) only (χ 2 test, p <0.001), while 23, 23 and 24 %, respectively, wished to receive ANH. Patients felt more confident about decisions on artificial nutrition (AN) than caregivers (T test, p < 0.05) and less concerned about adverse effects of forgoing ANH on pain, agitation and sensation of hunger and thirst (χ 2 test, p < 0.05). Satisfaction of patients with communication regarding forgoing ANH (5.0 ± 2.8 on a Likert scale from 0 to 10) correlated with their confidence (Spearman’s rho, p < 0.01). A thorough consultation with the attending physician on ANH issues was the favoured source of support for 77 % of patients and 97 % of relatives. A majority of patients considered their relatives’ opinion (67 %) and their own advance directives (62 %) as crucial for making ANH decisions, and 46 % of them had such a document completed.

Conclusion

Cancer patients and their relatives have similar preferences regarding ANH at the EoL, but relatives are reluctant to withhold AH if deciding for their loved one. While patients seem to be confident with ANH decision making, their caregivers may particularly benefit from discussing ANH options to dissipate fears.
Appendix
Available only for authorised users
Literature
1.
Domeisen Benedetti F, Ostgathe C, Clark J, Costantini M, Daud ML, Grossenbacher-Gschwend B et al (2013) International palliative care experts’ view on phenomena indicating the last hours and days of life. Support Care Cancer 21(6):1509–17PubMedCrossRef
2.
Raijmakers NJ, van Zuylen L, Costantini M, Caraceni A, Clark J, Lundquist G et al (2011) Artificial nutrition and hydration in the last week of life in cancer patients. a systematic literature review of practices and effects. Ann Oncol 22(7):1478–86PubMedCrossRef
3.
Prevost V, Grach MC (2012) Nutritional support and quality of life in cancer patients undergoing palliative care. Eur J Cancer Care Engl 21(5):581–90PubMedCrossRef
4.
Bruera E, Hui D, Dalal S, Torres-Vigil I, Trumble J, Roosth J et al (2013) Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, placebo-controlled randomized trial. J Clin Oncol 31(1):111–8PubMedCentralPubMedCrossRef
5.
Cohen MZ, Torres-Vigil I, Burbach BE, de la Rosa A, Bruera E (2012) The meaning of parenteral hydration to family caregivers and patients with advanced cancer receiving hospice care. J Pain Symptom Manag 43(5):855–65CrossRef
6.
Malia C, Bennett MI (2011) What influences patients’ decisions on artificial hydration at the end of life? A Q-methodology study. J Pain Symptom Manag 42(2):192–201CrossRef
7.
Morita T, Shima Y, Miyashita M, Kimura R, Adachi I (2004) Physician- and nurse-reported effects of intravenous hydration therapy on symptoms of terminally ill patients with cancer. J Palliat Med 7(5):683–93PubMedCrossRef
8.
Raijmakers NJ, Fradsham S, van Zuylen L, Mayland C, Ellershaw JE, van der Heide A (2011) Variation in attitudes towards artificial hydration at the end of life: a systematic literature review. Curr Opin Support Palliat Care 5(3):265–72PubMedCrossRef
9.
Chiu TY, Hu WY, Chuang RB, Cheng YR, Chen CY, Wakai S (2004) Terminal cancer patients’ wishes and influencing factors toward the provision of artificial nutrition and hydration in Taiwan. J Pain Symptom Manag 27(3):206–14CrossRef
10.
Morita T, Miyashita M, Shibagaki M, Hirai K, Ashiya T, Ishihara T et al (2006) Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan. J Pain Symptom Manag 31(4):306–16CrossRef
11.
Van der Riet P, Brooks D, Ashby M (2006) Nutrition and hydration at the end of life: pilot study of a palliative care experience. J Law Med 14(2):182–98PubMed
12.
Raijmakers NJ, van Zuylen L, Costantini M, Caraceni A, Clark JB, De Simone G et al (2012) Issues and needs in end-of-life decision making: an international modified Delphi study. Palliat Med 26(7):947–53PubMedCrossRef
13.
Jox RJ, Krebs M, Fegg M, Reiter-Theil S, Frey L, Eisenmenger W et al (2010) Limiting life-sustaining treatment in German intensive care units: a multiprofessional survey. J Crit Care 25(3):413–9PubMedCrossRef
14.
Idler E (1987) Religious involvement and the health of the elderly: some hypotheses and an initial test. Soc Forces 66(1):226–38CrossRef
15.
Zikmund-Fisher BJ, Sarr B, Fagerlin A, Ubel PA (2006) A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions. J Gen Intern Med 21(6):618–22PubMedCentralPubMedCrossRef
16.
Kuehlmeyer K, Borasio GD, Jox RJ (2012) How family caregivers’ medical and moral assumptions influence decision making for patients in the vegetative state: a qualitative interview study. J Med Ethics 38(6):332–7PubMedCentralPubMedCrossRef
17.
Jox RJ, Krebs M, Bickhardt J, Hessdorfer K, Roller S, Borasio GD (2008) How strictly should advance decisions be followed? the patients’ opinion. Palliat Med 22(5):675–6PubMedCrossRef
18.
Mercadante S, Ferrera P, Girelli D, Casuccio A (2005) Patients’ and relatives’ perceptions about intravenous and subcutaneous hydration. J Pain Symptom Manag 30(4):354–8CrossRef
19.
Rabkin J, Ogino M, Goetz R, McElhiney M, Marziliano A, Imai T et al (2013) Tracheostomy with invasive ventilation for ALS patients: neurologists’ roles in the US and Japan. Amyotroph Lateral Scler Frontotemporal Degener 14(2):116–23PubMedCrossRef
20.
German Medical Association principles of care of the dying [Grundsätze der Bundesärztekammer zur ärztlichen Sterbebegleitung]. Deutsches Ärzteblatt. 2004;101 (19):1298–9.
21.
Del Rio MI, Shand B, Bonati P, Palma A, Maldonado A, Taboada P et al (2012) Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology 21(9):913–21PubMedCrossRef
Metadata
Title
Decision making at the end of life—cancer patients’ and their caregivers’ views on artificial nutrition and hydration
Authors
J. Bükki
T. Unterpaul
G. Nübling
R. J. Jox
S. Lorenzl
Publication date
01-12-2014
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 12/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-014-2337-6

Other articles of this Issue 12/2014

Supportive Care in Cancer 12/2014 Go to the issue

Original Article

The dyadic effects of coping and resilience on psychological distress for cancer survivor couples

Original Article

Costs of care for lung and colon cancer patients receiving chemotherapy following FDA policy changes

Original Article

Smoking status, service use and associated factors among Japanese cancer survivors—a web-based survey

Original Article

Patient-reported outcomes are associated with patient-oncologist agreement of performance status in a multi-ethnic Asian population

Original Article

Psychologists’ views of inter-disciplinary psychosocial communication within the cancer care team

Original Article

‘Knowledge is power’: perceived needs and preferred services of male partners of women newly diagnosed with breast cancer
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits