Studying fluid status and the dying: The challenge of clinical research in palliative care.

The investigation of the effects of fluid status and fluid therapy on the dying illustrates some of the obstacles to doing palliative care clinical research. Fluid status and fluid therapy. Objectives. Investigate the effects of fluid status and fluid therapy on the dying. Setting. Two inpatient palliative care units (PCUs), one in Ottawa (Ott) and one in Edmonton (Edm). 123 patients were approached for participation and 94 consented. These were followed in Phase I until 70 were at clinical risk of developing a fluid deficit and started the main phase of the study. (Phase II). Hypodermoclysis was given to all patients in Edm to maintain optimal fluid balance. No parenteral fluids were administered to Ott patients. Patients remained in Phase II until their risk of fluid deficit resolved for 10 days. The groups showed differences in indicators of fluid status, with poorer fluid status, the Ott group. The groups displayed differences at the start of Phase II in several symptom-related outcomes. Median survival in Ott from the start of Phase II was four days, and in Edm was 31.5 days. Both groups showed deterioration in cognitive status close to death. Myoclonus was more prevalent in Ott as were pressure ulcers, but there were no differences in level of consciousness or prevalence of edema. Drugs with sedating effects and with anticholinergic effects were used more often in Ott, while corticosteroids and oxygen were used more in Edm. Clinical research obstacles which are particularly relevant to palliative care and strategies for dealing with them were identified. Sixty-nine studies were identified. Eight included comparison groups and six of these were randomized trials. Obstacles were classified into four main categories: problems caused by the patients' poor and unstable conditions; ethical concerns; population heterogeneity; and lack of relevant outcome measures. (Abstract shortened by UMI.