Premium
Decision‐Making and Outcomes of Feeding Tube Insertion: A Five‐State Study
Author(s) -
Teno Joan M.,
Mitchell Susan L.,
Kuo Sylvia K.,
Gozalo Pedro L.,
Rhodes Ramona L.,
Lima Julie C.,
Mor Vincent
Publication year - 2011
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2011.03385.x
Subject(s) - medicine , feeding tube , confidence interval , odds ratio , tube (container) , dementia , family medicine , surgery , disease , mechanical engineering , engineering
OBJECTIVES: To examine family member's perceptions of decision‐making and outcomes of feeding tubes. DESIGN: Mortality follow‐back survey. Sample weights were used to account for oversampling and survey design. A multivariate model examined the association between feeding tube use and overall quality of care rating regarding the last week of life. SETTING: Nursing homes, hospitals, and assisted living facilities. PARTICIPANTS: Respondents whose relative had died from dementia in five states with varying feeding tube use. MEASUREMENTS: Respondents were asked about discussions, decision‐making, and outcomes related to their loved ones' feeding problems. RESULTS: Of 486 family members surveyed, representing 9,652 relatives dying from dementia, 10.8% reported that the decedent had a feeding tube, 17.6% made a decision not to use a feeding tube, and 71.6% reported that there was no decision about feeding tubes. Of respondents for decedents with a feeding tube, 13.7% stated that there was no discussion about feeding tube insertion, and 41.6% reported a discussion that was shorter than 15 minutes. The risks associated with feeding tube insertion were not discussed in one‐third of the cases, 51.8% felt that the healthcare provider was strongly in favor of feeding tube insertion, and 12.6% felt pressured by the physician to insert a feeding tube. The decedent was often physically (25.9%) or pharmacologically restrained (29.2%). Respondents whose loved ones died with a feeding tube were less likely to report excellent end‐of‐life care (adjusted odds ratio=0.42, 95% confidence interval=0.18–0.97) than those who were not. CONCLUSION: Based on the perceptions of bereaved family members, important opportunities exist to improve decision‐making in feeding tube insertion.