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Variation in attitudes towards artificial hydration at the end of life: a systematic literature review

Raijmakers, Natasja J.H.a,b,*; Fradsham, Sarahc,*; van Zuylen, Liab; Mayland, Catrionac; Ellershaw, John E.c; van der Heide, Agnesaon behalf of OPCARE9

Current Opinion in Supportive and Palliative Care: September 2011 - Volume 5 - Issue 3 - p 265–272
doi: 10.1097/SPC.0b013e3283492ae0
End-of-life management: Edited by Gustavo De Simone

Purpose of review Artificial hydration in end-of-life care is an important and emotive topic that frequently raises concerns from patients, relatives and healthcare professionals (HCPs). The aim of this review was to give an overview of currently available evidence around opinions and attitudes towards artificial hydration at the end of life.

Recent finding In total 11 studies reported on opinions towards providing artificial hydration, nine studies reported on attitudes towards the effect of artificial hydration on quality-of-life and four studies towards its effect on survival. Reported percentages of respondents in favour of providing artificial hydration at the end of life varied from 22 to 100% and for nonprovision from 0 to 75%. One-third of the general public has been found to think that artificial hydration improves comfort, while among patients a majority feels it can have a physical or psychological benefit. HCPs were found to be less optimistic: 1–43% thought patients benefit from artificial hydration at the end of life. HCPs mostly agree artificial hydration does not prolong survival, although up to 89% of patients expect it does.

Summary Opinions and attitudes towards the use of artificial hydration at the end of life vary. Communication of this imperative topic in end-of-life care is important for better care and should be research-based.

aDepartment of Public Health

bDepartment of Medical Oncology, Erasmus MC, Rotterdam, The Netherlands

cMarie Curie Palliative Care Institute, University of Liverpool, UK

*Natasja J.H. Raijmakers and Sarah Fradsham contributed equally to the writing of this article.

Correspondence to Natasja J.H. Raijmakers, MSc, Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The NetherlandsTel: +0031 10 7043498; fax: +0031 10 7038475; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.