Factors associated with physician decision-making in starting tube feeding

Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions. Primary care physicians (n = 388) likely to manage nursing home patients in Hawaii were surveyed. Respondents indicated the factors of great importance i...

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Veröffentlicht in:Journal of palliative medicine 2008-07, Vol.11 (6), p.915-924
Hauptverfasser: Bell, Christina, Somogyi-Zalud, Emese, Masaki, Kamal, Fortaleza-Dawson, Theresa, Blanchette, Patricia Lanoie
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container_end_page 924
container_issue 6
container_start_page 915
container_title Journal of palliative medicine
container_volume 11
creator Bell, Christina
Somogyi-Zalud, Emese
Masaki, Kamal
Fortaleza-Dawson, Theresa
Blanchette, Patricia Lanoie
description Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions. 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. chi(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. Starting tube feeding (chosen by 31% of respondents) was associated with internal medicine specialty (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4-4.6), and placing great importance on family preference (OR 5.4, 95% CI 3.0-9.8) and liability (OR 2.5, 95% CI 1.3-4.8). After 3 months without improvement, 58% chose to withdraw tube feeding. Continuing tube feeding was associated with placing great importance on family wishes (OR 3.0, 95% CI 1.8-5.1) and liability (OR 1.7, 95% CI 1.0-2.9). Placing great importance on the living will was associated with decreased likelihoods of starting (OR 0.1, 95% CI 0.04-0.3) and continuing (OR 0.1, 95% CI 0.04-0.3) tube feeding. 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.
doi_str_mv 10.1089/jpm.2007.0289
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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. chi(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. Starting tube feeding (chosen by 31% of respondents) was associated with internal medicine specialty (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4-4.6), and placing great importance on family preference (OR 5.4, 95% CI 3.0-9.8) and liability (OR 2.5, 95% CI 1.3-4.8). After 3 months without improvement, 58% chose to withdraw tube feeding. Continuing tube feeding was associated with placing great importance on family wishes (OR 3.0, 95% CI 1.8-5.1) and liability (OR 1.7, 95% CI 1.0-2.9). Placing great importance on the living will was associated with decreased likelihoods of starting (OR 0.1, 95% CI 0.04-0.3) and continuing (OR 0.1, 95% CI 0.04-0.3) tube feeding. 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. 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source MEDLINE; Alma/SFX Local Collection
subjects Adult
Advance Directive Adherence
Attitude of Health Personnel
Chi-Square Distribution
Cross-Sectional Studies
Decision Making
Defensive Medicine
Enteral Nutrition
Female
Humans
Logistic Models
Male
Medical Futility
Middle Aged
Original
Physician-Patient Relations
Physicians, Family - psychology
Practice Patterns, Physicians
Professional-Family Relations
title Factors associated with physician decision-making in starting tube feeding
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