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Nurse Views of the Adequacy of Decision Making and Nurse Distress Regarding Artificial Hydration for Terminally Ill Cancer Patients: A Nationwide Survey

Department of Adult Nursing/Palliative Care Nursing, School of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, Japan, miyasita-tky{at}umin.net

Tatsuya Morita, MD

Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Shizuoka, Japan

Yasuo Shima, MD

Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan

Rieko Kimura, RN, MHlthSci

Keio University, Tokyo, Japan

Mikako Takahashi, RN, CNS

St. Luke's International Hospital, Tokyo, Japan

Isamu Adachi, MD

Shizuoka Cancer Center, Shizuoka, Japan

We evaluated nurse views on the adequacy of decision-making discussion among nurses and physicians regarding artificial hydration for terminally ill cancer patients and nurse distress arising from artificial hydration issues, as well as factors related to this distress. A self-administered questionnaire consisting of 4 questions about nurse views of discussions regarding artificial hydration and 6 questions about nurse distress arising from artificial hydration issues was distributed in participating institutions in October 2002 and returned by mail. A total of 3328 responses (79%) were analyzed. Almost half of the nurses felt that discussion of terminal hydration issues was insufficient. Among responses, 39% of oncology nurses and 78% of palliative care unit (PCU) nurses agreed that patients and medical practitioners discuss the issue of artificial hydration adequately, and 49% and 79%, respectively, agreed that medical practitioners discuss the issue of artificial hydration with other physicians adequately. As for distress on behalf of patients and families who refuse artificial hydration, 44% of oncology nurses and 57% of PCU nurses experienced such distress for patients, and 19% and 28% did so for families, respectively. Furthermore, 48% of oncology nurses and 47% of PCU nurses experienced distress arising from disagreements among medical practitioners about withholding artificial hydration, whereas 44% and 43% experienced distress about medical practitioners refusing artificial hydration, respectively. Discussion among care providers regarding artificial hydration is insufficient, particularly in general wards. Medical practitioners caring for terminally ill cancer patients should engage in greater discussion among patient-centered teams and facilitate individualized decision making.

Key Words: palliative care • attitude • fluid therapy • nurses • decision making • questionnaires

This version was published on January 1, 2008

American Journal of Hospice and Palliative Medicine®, Vol. 24, No. 6, 463-469 (2008)
DOI: 10.1177/1049909107302301


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