Originally published as JCO Early Release 10.1200/JCO.2003.10.155 on October 21 2002

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Attitudes of Japanese Physicians Toward Terminal Dehydration: A Nationwide Survey

From the Seirei Hospice, Seirei Mikatabara Hospital, Hamamatsu, Shizuoka; Department of Palliative Care, National Cancer Center Hospital East, Kashiwa, Chiba; and Department of Medical Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.

This article was published ahead of print at www.jco.org.Address reprint requests to Tatsuya Morita, MD, Seirei Hospice, Seirei Mikatabara Hospital, 3453 Mikatabara-cho, Hamamatsu, Shizuoka 433-8558, Japan; email: inomoteho{at}ma4.justnet.ne.jp

PURPOSE: To clarify physician attitudes toward terminal dehydration and identify the physician-related factors contributing to their attitudes.

METHODS: A cross-sectional survey of Japanese physicians with a self-reported questionnaire was used.

RESULTS: A total of 584 responses were analyzed (response rate, 53%). In the vignette of a gastric cancer patient with an estimated survival of 1 month and almost impossible oral intake due to intestinal obstruction, 50% chose intravenous hydration of 1,000 mL/d, while 24% selected more than 1,500 mL/d. For a lung cancer patient with cachexia, 58% chose 1,000 mL/d, while 26% selected no hydration or 500 mL. Multivariate analyses revealed that the physicians with more positive attitudes toward intravenous hydration were significantly less involved in end-of-life care, more likely to regard the physiologic requirement of fluid and nutrition as important in initiating intravenous hydration, more likely to believe that intravenous hydration is effective for symptom palliation, and more likely to believe that intravenous hydration is the minimum standard of care.

CONCLUSION: Physicians have considerably divergent attitudes toward intravenous hydration for terminally ill cancer patients. To resolve the discrepancy, the priority in hydration research should be to clarify the appropriate physiologic requirements of fluid and nutrition in dying patients, the effects of intravenous hydration on patient symptoms, and the reasons why physicians consider intravenous hydration to be the minimum standard of care.

The other members of the Japan Palliative Oncology Study Group involved in this survey are as follows: Toshihiro Matsuura, MD, Department of Gastroenterology, Chubu National Hospital, Aichi, Japan; Yoichiro Tamura, MD, Department of Surgery, Kasumigaura National Hospital, Ibaraki, Japan; and Shunya Uchida, MD, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.

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