Symptom Management, Nutrition and Hydration at End-of-Life: A Qualitative Exploration of Patients’, Carers’ and Health Professionals’ Experiences and Further Research Questions

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Research 1
Reference details
Baillie, J., Anagnostou, D., Sivell, S., Van Godwin, J., Byrne, A., & Nelson, A. (2018).
Symptom management, nutrition and hydration at end-of-life: a qualitative exploration of
patients’, carers’ and health professionals’ experiences and further research
questions. BMC palliative care, 17(1), 60. Retrieved from
https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-018-0314-4
Title & Abstract
Is the title appropriate? Yes. The title is appropriate because it indicates the problem
being studied. Additionally, the population and methodology
are clearly indicated in the title
Is there a structured abstract? Yes. There is a structured abstract which describes the key
elements of the research such as background, methods,
results, and conclusion.
The Study
Study Type Qualitative
Study Design Qualitative: Phenomenology
Was this Primary or Secondary
research?
Primary research: empirical study
Study Objective or Aims To provide a report on an additional analysis exploring the
experiences and question of the Palliative and end-of-life
care Priority Setting Partnership (PeolcPSP) survey
participants about symptoms, hydration and nutrition.
Setting in which the study was
conducted
The study was conducted in the UK. The PeolcPSP survey
gathered data from respondents across the UK using the
Survey Monkey link.
Inclusion / Exclusion Criteria Inclusion criteria: all residents in the UK willing to

Research 2
participate in the Monkey Survey
How was data collected? Survey
What data was collected? Primary data
How was the data analysed? Thematic analysis
What ethical considerations are
associated with the research?
Anonymity and confidentiality
Findings/Results
Sample size – How many
participants were included in the
research?
1403 respondents
Was the sample size justified? The sample size is not justified neither is there any logical
explanation for the size
Key Findings Five themes were recognized namely pain, breathing
difficulties, terminal anxiety, nutrition and hydration. 190
responses, representing 14% after coding were associated
with symptoms, nutrition and hydration. The respondents
were categorised into patients, current carer, bereaved carer,
professional, volunteer, and member of the public. The
subthemes for pain as perceived by the respondents include
evaluation, control and location of care; the complication in
breathing had control and respiratory secretions as the
subthemes. Additionally, hydration was viewed from the
perspectives of dehydration, threat, artificial hydration and
Liverpool Care Pathway; nutrition as ascertaining the need
and enteral feeding were developed as subthemes.
Discussion & Conclusion
What key points are raised in the
discussion?
A supplementary analysis of the PeolcPSP data obtained

Research 3
from the respondents namely patients, carers and medical
professionals were summarised into symptom management
based on evidence, location of care, and expert palliative
care. Under symptom management based on evidence the
bereaved carers were alarmed that pain was not adequately
explored in unconscious patients even those with dementia.
Surprisingly, the analysis shows that some carers are
convinced that health care experts do not examine the pain in
patients diagnosed with dementia or those who are
unconscious, and if pain assessment is done, then it is not
conveyed to the carers. It was also highlighted by some
respondents that an under-prescription of analgesia by some
medical practitioners increased pain in some patients and
that the uncertainty of doctors to administer analgesia to
patients under pain was worrying. Cases of food and drinks
being denied to patients in the last moments of their lives
were also raised by carers.
With regard to the place of care, the participants were
anxious about the best place to manage symptoms of pain,
whether in hospital or at home. The supplementary analysis
indicated that most of the carers were not contented with
pain alleviation at home and at hospital. The respondents
were dissatisfied with services provided by non-specialist
palliative care offered by health care professional in