Editorial

Informed Decision-Making Surrounding the Use of Chronic Enteral Nutrition: Let's Talk the Talk

Authors: Joseph W. Shega, MD

Abstract

Artificial nutrition through tube feeding is not unusual among persons with end stage dementia. It is estimated that about one-third of nursing home residents with advanced dementia are tube fed.1 This occurs even though the cited benefits of use; prolonging life, preventing aspiration, healing pressure ulcers, and providing comfort, do not appear to be supported by available evidence.2,3 The decision to place a feeding tube frequently occurs in an acute care setting and is made by a health care team that has not had a long standing relationship with the patient and family.4 Recommendations by the team are then often based on a “snapshot” of the patient so that appropriate medical decision-making is more challenging.

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References

1.Mitchell SL, Teno JM, Roy J, et al. Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 2003;290:73–80.
 
2.Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 1999;282:1365–1370.
 
3.Gillick MR. Rethinking the role of tube feeding in persons with advanced dementia. N Engl J Med 2000;342:206–210.
 
4.Callahan CM, Hagg KM, Buchanan N, et al. Decision-making for percutaneous endoscopic gastrostomy among older adults in the community setting. J Am Geriatr Soc 1999;47:1005–1009.
 
5.Swaminath A, Longstreth GF, Runnman Em, et al. Effect of physician education and patient counseling on inpatient nonsurgical percutaneous feeding tube placement rate, indications, and outcome. South Med J 2010;103:126–130.
 
6.Mazzini L, Corrà T, Zaccala M, et al. Percutaneous endoscopic gastrostomy and enteral nutrition in amyotrophic lateral sclerosis. J Neurol 1995;242:695–698.