JOURNAL OF PALLIATIVE MEDICINE Volume 10, Number 3, 2007 © Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2006.0254 Development of a National Clinical Guideline for Artificial Hydration Therapy for Terminally Ill Patients with Cancer TATSUYA MORITA, M.D., 1 SEIJI BITO, M.D., 2 HIROSHI KOYAMA, M.D., 3 YOSUKE UCHITOMI, M.D., Ph.D., 4 and ISAMU ADACHI, M.D. 5 ABSTRACT Background: Although differences in physician practices of artificial hydration therapy for termi- nally ill patients with cancer can cause unnecessary suffering from overhyrdration or underhydra- tion of patients, no clinical guideline is available in Japan. This paper illustrates a summary of a nationwide project to construct a clinical guideline for artificial hydration therapy. Methods: The Japanese Society of Palliative Medicine constructed a national multidisciplinary committee to develop a clinical guideline for artificial hydration therapy for terminally ill patients with cancer, using evidence-based and formal consensus-building methods with the Delphi tech- nique. Results: After systematic literature review, three sequential sessions of discussion using the Del- phi method, and an external review, a clinical guideline was established. This guideline includes gen- eral recommendations, specific recommendations (31 recommendations for medical aspects, 9 rec- ommendations for nursing, and 7 recommendations for ethics), background descriptions, case examples, communication examples, a complete reference list, and structured abstracts of all rele- vant original articles. Conclusion: The Japanese Society of Palliative Medicine constructed a clinical guideline for arti- ficial hydration therapy for terminally ill patients with cancer, using evidence-based and formal consensus-building methods. The clinical efficacy of this guideline should be tested in the future. 770 INTRODUCTION R ECENT LITERATURE revealed many differences in physician practice of artificial hydration therapy for terminally ill patients with cancer. 1 This means that patients may undergo unnecessary suffering from overhydration or underhydration. The establishment of a clinical guideline can contribute to patient well-be- ing by clarifying the best practice recommended from empirical evidence and expert experience available. To date, there are several clinical practice guidelines 2–7 ; however, they are general recommendations rather than for specific clinical questions and, in Japan, rel- evant guideline is unavailable. In this paper, we report the methodology of devel- oping a clinical guideline for artificial hydration ther- apy, general recommendations, and specific recom- mendations regarding quality-of-life–related medical 1 Department of Palliative and Supportive Care, Palliative Care Team, Seirei Hospice, Hamamatsu, Shizuoka, Japan. 2 Department of Internal Medicine, National Tokyo Medical Center, Tokyo, Japan. 3 Division of General Internal Medicine and Clinical Epidemiology, Kyoto Univesity Hospital, Kyoto, Japan. 4 Psycho-Oncology Division, Research Center for Innovative Oncology, National Cancer Center Research Institute East, Chiba, Japan. 5 Department of Palliative Medicine, Shizuoka Cancer Center, Shizuoka, Japan.