Opinion of artificial hydration varies by ethnicity

By Sarah Guy, MedWire Reporter

Ethnicity influences whether patients at the end of life and their carers view artificial hydration (AH) as food or medicine, with more individuals from ethnic minorities viewing it as food than non-Hispanic European Americans, show US study results.

The finding could have important implications for the best and most patient-oriented approaches to end-of-life care, say the researchers.

"Identifying some of the beliefs and barriers regarding the decision-making process in this challenging area may provide preliminary evidence for culturally appropriate end-of-life communication strategies and care that incorporates individual assessments of the pros and cons of hydrating in each particular context," suggest Isabel Torres-Vigil (University of Houston, Texas) and co-investigators.

Their interview-based study also revealed a discrepancy between how patients and caregivers view AH compared with medical professionals, who largely regard it as a medical treatment, and not as basic care, which makes a difference when considering whether to withhold or discontinue it.

A total of 122 terminally ill cancer patients and caregivers of such patients provided an answer to the question: "Are these fluids more like food or more like medicine?", which Torres-Vigil and colleagues categorized as either food, medicine, both, or other.

In all, 38% of patients saw AH more like food, 34% saw it more like medicine, 14% saw it as both, and 14% saw it as "other," including vitamins and saline. Significantly more ethnic minority respondents saw it as food compared with non-Hispanic European Americans, at 66% versus 42%.

After the results were adjusted for age and gender, the significant ethnic difference persisted, with an odds ratio of 2.7 for ethnic minorities viewing AH as food.

The researchers report no significant differences in participants' views according to gender, age, caregivers' relationship to the patient, group assignment, disease severity, or cancer type.

"Culture, understood as the compilation of shared meanings, values, rituals and modes of interacting with others that inform how people view and understand the world, may strongly influence attitudes and preferences related to end-of-life care," write Torres-Vigil et al in BMJ Supportive & Palliative Care.

The team suggests that in instances of advanced cancer when patients begin to decrease their oral intake of fluids, healthcare professionals should ask patients and/or their caregivers what perceptions they have regarding the role of AH.

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