Decision-making and outcomes of feeding tube insertion: A five-state study

Joan Teno, Susan L. Mitchell, Sylvia K. Kuo, Pedro L. Gozalo, Ramona L. Rhodes, Julie C. Lima, Vincent Mor

Research output: Contribution to journalArticle

83 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)881-886
Number of pages6
JournalJournal of the American Geriatrics Society
Volume59
Issue number5
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

Enteral Nutrition
Decision Making
Dementia
Assisted Living Facilities
Terminal Care
Quality of Health Care
Nursing Homes
Health Personnel
Surveys and Questionnaires
Odds Ratio
Confidence Intervals

Keywords

  • decision-making
  • dementia
  • feeding tube insertion
  • outcomes

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Decision-making and outcomes of feeding tube insertion : A five-state study. / Teno, Joan; Mitchell, Susan L.; Kuo, Sylvia K.; Gozalo, Pedro L.; Rhodes, Ramona L.; Lima, Julie C.; Mor, Vincent.

In: Journal of the American Geriatrics Society, Vol. 59, No. 5, 01.05.2011, p. 881-886.

Research output: Contribution to journalArticle

Teno, Joan ; Mitchell, Susan L. ; Kuo, Sylvia K. ; Gozalo, Pedro L. ; Rhodes, Ramona L. ; Lima, Julie C. ; Mor, Vincent. / Decision-making and outcomes of feeding tube insertion : A five-state study. In: Journal of the American Geriatrics Society. 2011 ; Vol. 59, No. 5. pp. 881-886.
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