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Spring 2014
BMM Current Issue
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To Tube or Not To Tube?
Ask the patient.
Researchers from Brown University and Harvard Medical School are calling for improved decision making in the use of feeding tubes for nursing home residents with advanced dementia. Their findings were presented in the February 10 issue of the Journal of the American Medical Association.

Their opinion is based on an eight-year study of more than 280,000 hospital admissions of nursing home residents at nearly 2,800 acute-care hospitals, which found that the use of feeding tubes varies widely. Medical evidence has long suggested that feeding tubes do not improve survival or overall outcomes in patients with dementia, a terminal illness that affects a patient’s mind and eventually the ability to eat.

“Our results suggest that decisions to insert a feeding tube in persons with advanced dementia are more about which hospital you are admitted to than a decision-making process that elicits and supports patient choice,” says Joan M. Teno, lead author and professor of community health and medicine. Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube. Larger or for-profit hospitals tended to use them more frequently. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

The findings point to a clear need to examine how treatment decisions are made for patients with advanced dementia, and to ensure that the decisions reflect patient wishes and values. Says Teno: “As we reform our health care system, ensur[ing] patient choice [is] key.”

The research teams will publish hospital rates of feeding tube insertions on its website,
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