American Journal of Hospice and Palliative Medicine®

 

Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

Register here to gain access to SAGE's 500+ Journals Online

Click here to sign up for SAGE Journal Email Alerts today!

Sign In to gain access to subscriptions and/or personal tools.
This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miyashita, M.
Right arrow Articles by Adachi, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miyashita, M.
Right arrow Articles by Adachi, I.
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
This version was published on November 1, 2007
American Journal of Hospice and Palliative Medicine®, Vol. 24, No. 5, 383-389 (2007)
DOI: 10.1177/1049909107300552

Physician and Nurse Attitudes Toward Artificial Hydration for Terminally Ill Cancer Patients in Japan: Results of 2 Nationwide Surveys

Mitsunori Miyashita, RN, PhD

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

Tatsuya Morita, MD

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

Yasuo Shima, MD

Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki

Rieko Kimura, RN, MHlthSci

Keio University, Tokyo

Mikako Takahashi, RN, CNS

St. Luke's International Hospital, Tokyo

Isamu Adachi, MD

Shizuoka Cancer Center, Shizuoka Japan

This study investigated physician and nurse attitudes toward artificial hydration in terminally ill cancer patients and compared differences in attitudes between these 2 professions and among clinical settings in Japan. The response rate was 53% (584/1123) for physicians and 79% for nurses (3328/4210). More physicians answered that artificial hydration alleviates the sensation of thirst. More palliative care unit physicians and nurses answered that withholding artificial hydration alleviated several physical symptoms. Oncologists answered that artificial hydration alleviated the sensation of thirst and fatigue. Discussion among patient-centered teams and individualized decision making are important. Because the differences identified here are attributable to differences in knowledge of artificial hydration for terminal cancer patients, oncologists should place greater emphasis on the opinion of palliative care specialists. Medical practitioners caring for terminal cancer patients should consider a broader range of views on hydration therapy, with a focus on effective hydration techniques and alternative interventions.

Key Words: palliative care • fluid therapy • attitude

References

  • McCann RM, Hall WJ, Groth-Juncker A. Comfort care for terminally ill patients. The appropriate use of nutrition and hydration. JAMA. 1994;272:1263-1266.[Abstract]
  • Viola RA, Wells GA, Peterson J. The effects of fluid status and fluid therapy on the dying: a systematic review. J Palliat Care. 1997;13:41-52.[Medline] [Order article via Infotrieve]
  • Morita T., Hyodo I., Yoshimi T., et al. Association between hydration volume and symptoms in terminally ill cancer patients with abdominal malignancies. Ann Oncol. 2005; 16:640-647.[Abstract/Free Full Text]
  • Fainsinger RL, Bruera E. When to treat dehydration in a terminally ill patient? Support Care Cancer. 1997;5: 205-211.[CrossRef][Medline] [Order article via Infotrieve]
  • Ripamonti C., Twycross R., Baines M., et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9:223-233.[CrossRef][Medline] [Order article via Infotrieve]
  • Musgrave CF, Bartal N., Opstad J. The sensation of thirst in dying patients receiving i.v. hydration. J Palliat Care. 1995;11:17-21.[Medline] [Order article via Infotrieve]
  • Zerwekh JV The dehydration question. Nursing. 1983; 13:47-51.[Medline] [Order article via Infotrieve]
  • Burge FI Dehydration symptoms of palliative care cancer patients. J Pain Symptom Manage. 1993;8:454-464.[CrossRef][Medline] [Order article via Infotrieve]
  • Craig GM On withholding artificial hydration and nutrition from terminally ill sedated patients. The debate continues. J Med Ethics. 1996;22:147-153.[Abstract]
  • De Ridder D., Gastmans C. Dehydration among terminally ill patients: an integrated ethical and practical approach for caregivers. Nurs Ethics. 1996;3:305-316.[Abstract/Free Full Text]
  • Chiu TY, Hu WY, Cheng SY, Chen CY Ethical dilemmas in palliative care: a study in Taiwan. J Med Ethics. 2000; 26:353-357.[Abstract/Free Full Text]
  • Morita T., Shima Y., Adachi I.; Japan Palliative Oncology Study Group. Attitudes of Japanese physicians toward terminal dehydration: a nationwide survey. J Clin Oncol. 2002;20:4699-4704.[Abstract/Free Full Text]
  • Morita T., Shima Y., Miyashita M., Kimura R., Adachi I., Japan Palliative Oncology Study Group. Physician- and nurse-reported effects of artificial hydration therapy on symptoms of terminally ill patients with cancer. J Palliat Med. 2004;7:683-693.[CrossRef][Medline] [Order article via Infotrieve]
  • Parkash R., Burge F. The family's perspective on issues of hydration in terminal care. J Palliat Care. 1997;13:23-27.[Medline] [Order article via Infotrieve]
  • Morita T., Tsunoda J., Inoue S., Chihara S. Perceptions and decision-making on rehydration of terminally ill cancer patients and family members. Am J Hosp Palliat Care. 1999;16:509-516.[Abstract/Free Full Text]
  • Micetich KC, Steinecker PH, Thomasma DC Are intravenous fluids morally required for a dying patient? Arch Intern Med. 1983;143:975-978.[CrossRef][Medline] [Order article via Infotrieve]
  • Marin PP, Bayer AJ, Tomlinson A., Pathy MS Attitudes of hospital doctors in Wales to use of intravenous fluids and antibiotics in the terminally ill. Postgrad Med J. 1989;65:650-652.[Abstract]
  • Collaud T., Rapin CH Dehydration in dying patients: study with physicians in French-speaking Switzerland. J Pain Symptom Manage. 1991;6:230-240.[CrossRef][Medline] [Order article via Infotrieve]
  • Bozzetti F., Amadori D., Bruera E., et al. Guidelines on artificial nutrition versus hydration in terminal cancer patients. European Association for Palliative Care. Nutrition. 1996;12:163-167.[CrossRef][Medline] [Order article via Infotrieve]
  • Musgrave CF, Bartal N., Opstad J. Intravenous hydration for terminal patients: what are the attitudes of Israeli terminal patients, their families, and their health professionals? J Pain Symptom Manage. 1996;12:47-51.[CrossRef][Medline] [Order article via Infotrieve]
  • Meares CJ Primary caregiver perceptions of intake cessation in patients who are terminally ill. Oncol Nurs Forum. 1997;24:1751-1757.[Medline] [Order article via Infotrieve]
  • Cerchietti L., Navigante A., Sauri A., Palazzo F. Hypodermoclysis for control of dehydration in terminal-stage cancer. Int J Palliat Nurs. 2000;6:370-374.[Medline] [Order article via Infotrieve]
  • Anonymous. Terminal dehydration. Lancet. 1986;1:306.[Medline] [Order article via Infotrieve]
  • Wanzer SH, Federman DD, Adelstein SJ, et al. The physician's responsibility toward hopelessly ill patients. A second look. N Engl J Med. 1989;320:844-849.[Abstract]
  • Meares CJ Terminal dehydration: a review. Am J Hosp Palliat Care. 1994;11:10-14.[Medline] [Order article via Infotrieve]
  • Steiner N., Bruera E. Methods of hydration in palliative care patients. J Palliat Care. 1998;14:6-13.[Medline] [Order article via Infotrieve]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Miyashita, M.
Right arrow Articles by Adachi, I.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Miyashita, M.
Right arrow Articles by Adachi, I.
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?