Decision-Making and Outcomes of Feeding Tube Insertion: A Five-State Study

Authors

  • Joan M. Teno MD, MS,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Susan L. Mitchell MD, MPH,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Sylvia K. Kuo PhD,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Pedro L. Gozalo PhD,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Ramona L. Rhodes MD, MPH,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Julie C. Lima PhD, MPH,

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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  • Vincent Mor PhD

    1. From the *Health Services, Policy, and Practice, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island; Hebrew Senior Life Institute for Aging Research, Roslindale, Massachusetts; and Department of Geriatric Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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Address correspondence to Joan M. Teno, Professor of Community Health and Medicine and Associate Medical Director, Home and Hospice Care of RI, 121 South Main Street, Providence, RI 02912. E-mail: joan_teno@brown.edu

Abstract

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.

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