ABSTRACT
BACKGROUND: Since the revision of the french law in 2016, artificial hydration is considered as a treatment and its withdrawal is part of the fight against extraordinary treatment at the end of life. Given its symbolism, the decision of withdrawal can be difficult for the patient, his or her entourage, and caregivers. The objective of this study was to assess the benefits and risks associated with artificial hydration (AH) at the end of life and the existing means of communication around this decision. METHOD: Systematic review of the literature from the Pubmed® search engine, between 2011 and 2021, in French or English by four researchers. RESULTS: Among the 102 articles identified, the eleven studies included were in favor of no effect of AH on the quality and duration of survival. A reduction in AH appeared to reduce symptoms related to fluid overload and may be related to better quality of end of life or dying. Dry mouth was the most recurrent discomfort associated with AH reduction or discontinuation. Regular mouth care could prevent this discomfort. A clinical trial with patient education seemed to increase indecision about stopping AH. CONCLUSION: Despite the lack of good quality studies, the benefit-risk balance of AH does not seem to favour its continuation. Communication tools such as videos or multidisciplinary programs could reduce the decisional conflict of patients, their families and caregivers.
