Factors Associated with Physician Decision-Making in Starting Tube Feeding

Abstract

Background:Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions.Methods: Primary care physicians (n ‫؍‬ 388) likely to manage nursing home patients in Hawaii were surveyed. Respondents indicated the factors of great importance in tube feeding decisions based on a vignette of a poststroke patient failing to thrive and family disagreement with advance directives. 2 and multiple logistic regression analyses were used to examine associations between physician demographics and factors of importance to physicians and their decisions based on the vignette. Conclusions: The decision to start or withhold tube feeding is associated with the individual physician's perception of the importance of patient wishes versus family wishes and liability concerns. Physician awareness of the influence of these factors on medical decisions may improve the decision-making process.

Regional Comparison of Enteral Nutrition–Related Admission Policies in Skilled Nursing Facilities

“…That one interviewee lamented that NGFT would be more acceptable “if there were a way to secure the tube” is consistent with previous assertions that nasal bridles are underused 22 , despite the fact that they have been demonstrated to be a safe and effective way to reduce dislodgment and ensure adequate feeding 22-24 . Our finding that SNF administrators were concerned about liability is consistent with a vignette-based survey study of primary care physicians (PCPs) in Hawaii in which PCPs who indicated that they would start tube feeding in fictional patients with dementia were also significantly more likely to place great importance on liability concerns as their motivation for doing so 43 .…”

How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

“…Informal spoken wishes of patients were also thought to be important in the decision-making process [42], [66], [67], [84], [85], [89], [90]. However, verbal wishes expressed once a person’s disease had progressed were sometimes considered untrustworthy [54].Within studies of dementia and ABI, non-verbal signals, such as pushing food away, were frequently incorporated into an assessment of presumed wishes [35], [36], [47], [48], [52], [66], [68], [87].…”

End of Life Care: Attitudes Toward Autonomy and Legal Instruments

“…The option to start or withhold tube feeding or gastrostomy is controversial and includes the physician's perception of patient and family wishes and liability concerns (Bell et al, 2008). For some authors the evidence that dysphagia is always a terminal symptom in dementia rules out the recommendation to use gastrostomy (Regnad et al, 2010).…”