Priority 22 from the Palliative and end of life care PSP

UNCERTAINTY: Is there an appropriate time to withdraw artificial hydration and nutrition (for example, a drip) and how can this be done sensitively and consensually? What is the best way to communicate with the carers and family about this process? (JLA PSP Priority 22)
Overall ranking	22
JLA question ID	0026/22
Evidence	Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J. Medically assisted hydration for adult palliative care patients. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD006273. DOI: 10.1002/14651858.CD006273.pub3. Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J. Medically assisted nutrition for adult palliative care patients. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD006274. DOI: 10.1002/14651858.CD006274.pub3.
Health Research Classification System category	Generic

Extra information provided by this PSP
Original uncertainty examples	What is the role of hydration and sedation at the end of life? ~ Further research regarding artificial hydration / nutrition at the end of life (especially the last few weeks) is important in order to guide clinical practice where possible. ~ The practice of maintaining hydration/nutrition seems variable and inconsistent across patients/hospitals. ~ How can the withdrawal of these be done in a sensitive and consensual way for person, family and medical/caring staff?
Submitted by	Professionals x 1 ~ Carers x 1
Outcomes to be measured	Change in symptoms; change in management of symptoms.

PSP information
PSP unique ID	0026
PSP name	Palliative and end of life care
Total number of uncertainties identified by this PSP.	83 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	21 November 2014