Clinically-assisted hydration (CAH) at the end-of-life is one of the most contentious issues in medicine, partly due to the fact that there is no good data to support/refute its use in this scenario.Methods
The study was a cluster randomised trial (feasibility study) comparing CAH with oral care in patients with advanced cancer receiving end-of-life care under palliative care teams in 12 hospices/hospitals in the UK. The main outcomes related to the feasibility of conducting a definitive study, whilst the clinical outcomes included the prevalence of end-of-life care symptoms (particularly hyperactive delirium), adverse effects, and overall survival.Results
200 patients were recruited in 1 year, and all feasibility criteria were achieved. The prevalence of delirium was similar in the two groups, although the onset of delirium was delayed in the CAH group (112 hour versus 58 hour). Similar results were seen for excess respiratory secretions (”death rattle”). Median survival was greater in the CAH group (i.e. 5 days versus 3 days). Thirty-eight percent patients discontinued CAH due to perceived adverse effects (e.g. localised swelling, respiratory secretions).Conclusion
Interventional trials are possible in patients at the end-of-life, but the methodology needs to be somewhat adapted. The results of the feasibility study suggest that CAH may have a positive influence of end-of-life problems, and possibly survival. However, a larger/definitive study is required to confirm these findings. CAH is associated with adverse effects in some patients, but these may be less than perceived by palliative care specialists.