Perceptions and decision-making on rehydration of terminally ill cancer patients and family members

Abstract

Although the appropriateness of forced rehydration for terminally ill cancer patients has been actively discussed, few studies have investigated its psychological aspects. To clarify patients' and family members' perceptions about rehydration and identify contributing factors for decision-making, a prospective structured survey was performed on 121 hospice inpatients with insufficient oral intake. Physicians did not recommend rehydration in 78 percent of patients, and 75 percent decided not to receive artificial fluid therapy. Various concerns affected decision-making: 76 percent of patients and 85 percent of family members believed patients could not get appropriate nutrition without artificial rehydration. Some 56 percent of patients and 84 percent of family members said that withholding rehydration would cause premature death, while more than half agreed that forced rehydration might worsen the patients' suffering. Patients' performance status, fluid retention signs, denial, physicians' recommendations, patients' and family members' beliefs about the effect of hydration on patients' distress, and family members' anxiety about withholding rehydration were significantly associated with decision-making. Multiple regression analyses revealed patients' denial, physicians' recommendations determined by patients' performance status and fluid retention symptoms, and family members' belief that rehydration could worsen patients' distress as independent determinants for rehydration. In conclusion, hospice care receivers had various concerns about rehydration, related to patients' nutrition, survival, and distress. The main determinants for rehydration therapy were patients' performance status, fluid retention symptoms, denial, and care receivers' beliefs about the effect of hydration on the patients' distress.