title: Practice patterns and perceptions about parenteral hydration in the last weeks of life: a survey of palliative care physicians in Latin America.
abstract: BACKGROUND
  Parenteral hydration at the end of life is controversial and has generated considerable debate for decades.
  
  
  OBJECTIVE
  To identify palliative care physician parenteral hydration prescribing patterns and factors that influence prescribing levels (PLs) for patients during their last weeks of life.
  
  
  METHODS
  A cross-sectional, representative online survey of Latin American palliative care physicians was conducted in 2010. Physicians were asked to report the percentage of their terminally ill patients for whom they prescribed parenteral hydration. Predictors of parenteral hydration PLs were identified using logistic regression analysis.
  
  
  RESULTS
  Two hundred thirty-eight of 320 physicians completed the survey (74% response rate). Sixty percent of physicians reported prescribing parenteral hydration to 40%-100% of their patients during the last weeks of life. Factors influencing moderate/high PLs were the following: agreeing that parenteral hydration is clinically and psychologically efficacious (odds ratio [OR] 3.5; 95% confidence interval [CI] 1.5-8.3), disagreeing that withholding parenteral hydration alleviates symptoms (OR 3.3, 95% CI 1.3-8.1), agreeing that parenteral hydration is essential for meeting the minimum standards of care (OR 3.2, 95% CI 1.4-7.5), preferring the subcutaneous route of parenteral hydration for patient comfort and home use (OR 2.9, 95% CI 1.3-6.5), and being younger than 45 years of age (OR 2.6, 95% CI 1.3-5.2).
  
  
  CONCLUSIONS
  The strongest determinant of prescribing patterns was agreement with the clinical/psychological efficaciousness of parenteral hydration. Our results reflect parenteral hydration prescribing patterns and perceptions that substantially differ from the conventional/traditional hospice philosophy. These findings suggest that the decision to prescribe or withhold parenteral hydration is largely based on clinical perceptions and that most palliative care physicians from this region of the world individualize treatment decisions.
authors.affiliation: Graduate College of Social Work, University of Houston, Houston, Texas, USA. istorres@uh.edu
authors.forename: Isabel
authors.initials: I
authors.lastname: Torres-Vigil
authors.forename: Tito R
authors.initials: TR
authors.lastname: Mendoza
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Babarro
authors.forename: Liliana
authors.initials: L
authors.lastname: De Lima
authors.forename: Marylou
authors.initials: M
authors.lastname: Cárdenas-Turanzas
authors.forename: Mike
authors.initials: M
authors.lastname: Hernandez
authors.forename: Allison
authors.initials: A
authors.lastname: de la Rosa
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002908:Chronic Disease / Q000401:mortality / Q000451:nursing / Q000523:psychology; D005260:Female; D005440:Fluid Therapy / Q000941:ethics / Q000706:statistics & numerical data*; D006801:Humans; D007843:Latin America / Q000453:epidemiology; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology / Q000706:statistics & numerical data*; D010288:Parenteral Nutrition / Q000523:psychology / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013727:Terminal Care / Q000523:psychology / Q000706:statistics & numerical data*; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data*