No abstract

A greater proportion of patients have feedings tubes inserted because of a degenerative dementia in Boston compared with an acute neurological event in Ottawa. Despite the difference in diagnostic indication for tube-feeding, the substitute decision-making process was seriously limited at both sites by poor implementation of the principle of substituted judgement, a need for broader advance directives, and improved transfer of knowledge between clinicians and decision-makers.

Interventions such as the ones implemented can lead to fewer hospital transfers for SNUs.