CHELsea (Synopsis)

Background

In response to concerns raised about the provision of hydration to patients in the last days of life{1-3}, the University of Surrey is undertaking a feasibility study to investigate the benefits and risks of so-called clinically-assisted hydration (fluid given by a drip) in this particular group of patients{4}.

The study is funded by the Research for Patient Benefit Programme of the National Institute of Health Research (National Health Service){5}, and the study team includes experienced researchers in the area of palliative care / end-of-life care.

 

What is the current standard of care?

Currently, there is no standard of care within the United Kingdom: in some hospitals / hospices clinically-assisted hydration is given routinely, but in most units it is only given in specific cases. The reason for the disparity is the lack of research to either support / refute the use of clinically-assisted hydration in this situation {3}. In units that do not routinely use clinically-assisted hydration, the standard of care is to support the patient to drink, to give regular mouth care (moistening the lips / mouth), in addition to other routine comfort measures.

 

What will happen during the study?

The study is being conducted in 12 units (4 hospitals, 8 hospices) in England and Wales: 50% of the units will routinely give their cancer patients support to drink, mouth care and other standard comfort measures, whilst 50% of the units will routinely give their cancer patients clinically-assisted hydration as well as support to drink, mouth care and other standard comfort measures.

Eligible patients (and / or their carers) will be given the option to take part in the study: patients that are enrolled in the study will be managed in exactly the same manner as patients not enrolled in the study, except information about their symptoms, and about the use of medication to control their symptoms, will be shared with the researchers from the University of Surrey.

Irrespective of the unit’s routine practice, the decision to give / withhold clinically-assisted hydration in an individual patient will be made by the clinical team caring for that patient (and based on their clinical condition). Furthermore, the clinical team are expected to review this aspect of care on a day-to-day basis.

 

What is the aim of the study?

Ultimately, we want to determine whether or not clinically-assisted hydration is beneficial in cancer patients in the last days of life. In particular, we want to see whether clinically-assisted hydration prevents the development of problems such as agitation (restlessness), or promotes the development of other problems such as respiratory secretions (noisy breathing). However, the aim of this feasibility study is to determine whether a larger (definitive) study is possible, and whether or not the study methods would need to be changed in order to complete a larger study.

 

References

{1}. Allen E. Elderly patients are being 'deprived of food and drink so they die quicker and free up bed space', claim doctors. Daily Mail: published 9th July 2012.

Available from:

http://www.dailymail.co.uk/news/article-2170792/Elderly-patients-deprived-food-drink-die-quicker-save-hospitals-money.html

{2}. Whitehorn K. A thirst for palliative care: the Liverpool Care Pathway and withholding sustenance. The Observer: published 30th December 2012.

           Available from:

http://www.guardian.co.uk/lifeandstyle/2012/dec/30/controversial-liverpool-care-pathway-palliative?INTCMP=SRCH

{3}. Neuberger J, Aaronovitch D, Bonset T, Charlesworth-Smith C, Cox D, Guthrie C, Hameed K, Harries R, Jackson R, Waller S. More care, less pathway. A review of the Liverpool Care Pathway. Published online July 2013.

Available from:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf

{4}. Study entry on ClinicalTrials.gov website:

               https://clinicaltrials.gov/ct2/show/NCT02344927?term=hydration&rank=9

{5}. National Institute for Health Research website:

           http://www.nihr.ac.uk/research/

Further information

Queries about this press release / the study should be directed to:

Peter La <mediarelations@surrey.ac.uk>