Table 4, Review protocol: Clinically assisted hydration - Care of Dying Adults in the Last Days of Life

Component	Description
Review question	In patients in their last days of life, is clinically assisted hydration effective in improving symptoms and general comfort?
Objectives	To identify whether clinically assisted hydration is effective in the clinical management of a patient in their last days of life.
Population	Adult people in the last days of life who are not maintaining sufficient oral hydration.
Interventions	Clinically assisted hydration Enteral hydration (via nasogastric tube, gastrostomy or jejunostomy) Parenteral hydration (intravenously or subcutaneously).
Comparator	Placebo, for example, clinically insignificant amounts No intervention Oral hydration only.
Outcomes	Critical: Quality of life (either patient-rated, clinician-rated, carer-rated) Symptom improvement on rating scales pre and post intervention. Important: Hydration status using both objective and subjective measures (for example, hydration of oral mucosa, measuring vital signs and skin turgor). Adverse events both procedural (phlebitis, or line infections, for example) and from positive fluid balance (for example, pleural effusions). Subjective ratings from informal carers on quality of care received. Biochemistry results including urea, creatinine and sodium.
Study design	RCT Prospective cohort study Systematic Review Exclusions: Cohort Case series Case reports Narrative summaries (including literature reviews).
Population size and directness	No restrictions.
Setting	All settings.
Search strategy	The databases to be searched are Medline, Embase, The Cochrane Library, CINAHL, PsychINFO Studies will be restricted to English language only.
Review strategy	Appraisal of methodological quality. The methodological quality of each study will be assessed using NICE checklists and the quality of the evidence will be assessed by GRADE for each outcome. Synthesis of data. Meta-analysis will be conducted where appropriate. Data on the following groups will be presented separately, if the evidence allows: Dementia or other cognitive impairment Learning disabilities.

Component

Description

Review question

In patients in their last days of life, is clinically assisted hydration effective in improving symptoms and general comfort?

Objectives

To identify whether clinically assisted hydration is effective in the clinical management of a patient in their last days of life.

Population

Adult people in the last days of life who are not maintaining sufficient oral hydration.

Interventions

Clinically assisted hydration

Enteral hydration (via nasogastric tube, gastrostomy or jejunostomy)
Parenteral hydration (intravenously or subcutaneously).

Comparator

Placebo, for example, clinically insignificant amounts
No intervention
Oral hydration only.

Outcomes

Critical:

Quality of life (either patient-rated, clinician-rated, carer-rated)
Symptom improvement on rating scales pre and post intervention.

Important:

Hydration status using both objective and subjective measures (for example, hydration of oral mucosa, measuring vital signs and skin turgor).
Adverse events both procedural (phlebitis, or line infections, for example) and from positive fluid balance (for example, pleural effusions).
Subjective ratings from informal carers on quality of care received.
Biochemistry results including urea, creatinine and sodium.

Study design

RCT
Prospective cohort study
Systematic Review

Exclusions:

Cohort
Case series
Case reports
Narrative summaries (including literature reviews).

Population size and directness

No restrictions.

Setting

All settings.

Search strategy

The databases to be searched are Medline, Embase, The Cochrane Library, CINAHL, PsychINFO
Studies will be restricted to English language only.

Review strategy

Appraisal of methodological quality.
The methodological quality of each study will be assessed using NICE checklists and the quality of the evidence will be assessed by GRADE for each outcome.
Synthesis of data.
Meta-analysis will be conducted where appropriate.

Data on the following groups will be presented separately, if the evidence allows:

Dementia or other cognitive impairment
Learning disabilities.

From: Appendix C, Clinical review protocols

Care of Dying Adults in the Last Days of Life.

NICE Guideline, No. 31.

National Clinical Guideline Centre (UK).

London: National Institute for Health and Care Excellence (NICE); 2015 Dec 16.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Table 4Review protocol: Clinically assisted hydration