The Why Behind the Feeding Tube Decision

In caregiving, some decisions carry an emotional charge unlike any other life decision. The decision about a feeding tube for your caree is one of those decisions.

A feeding tube can be a helpful option during a time when your caree will recover (from a surgery, for instance). For those nearing end of life, the feeding tube causes discomfort without extending survival. Some studies show that a feeding tube can reduce quality of life.

And, yet, about one-third of nursing home residents have feeding tubes, with the overwhelming majority inserted during a hospitalization. A 2010 study from Dr. Joan M. Teno of Brown University in Providence, R.I., indicated that feeding tubes are overused in persons with dementia.

Dr. Teno recently led another study, with researchers from the Hebrew Senior Life Institute for Aging Research in Massachusetts, and the University of Texas Southwestern Medical Center, to understand the “why” behind doctors’ decisions to insert a feeding tube.

Their findings, gained from interviews with family members of hospital patients with feeding tubes:

  • 13.7% of family members who said their family member (caree) received a feeding tube stated that medical providers inserted the tube without discussing it first;
  • 11.2% said they felt pressured by the physician to put in a feeding tube;
  • 38.2% believed that that physician was strongly in favor of feeding tube insertion;
  • 41.6% of the time the discussion regarding feeding tube insertion lasted less than 15 minutes;
  • 39.3% did not discuss the risks of feeding tubes.

Ugh. It’s upsetting to read these stats because:

  • I would hope physicians know better;
  • I would hope physicians would take time to fully discuss the impact of a feeding tube with family members;
  • I would hope physicians would know better.

In an article today by Paula Span in The New York Times, Dr. Teno shares a theory as to why feeding tubes are inserted during a hospitalization: It speeds up discharge time. (As you know, hospital staff regularly push to discharge patients as soon as possible.) Paula’s guess? Physicians’ discomfort about talking about advanced dementia as a terminal disease.

Most likely, it’s a combination of both theories. And, that’s just too bad. Comfort at life’s end is a goal we have. It’s awful when the hospital system doesn’t give us enough time or information to make the decision that can create that comfort. And, it’s unsettling to wonder if physicians really practice avoidance of difficult discussions.

What do you think? Please share your thoughts and experiences in our comments section, below

Resources

  • Ask the Nurse: Should My Mom Get a Feeding Tube?
  • What’s caregiving like for you? Share your experiences in our 2011 Annual Family Caregiver Survey; get a 30-minute coaching session with Denise and a chance to win a $100 Amazon.com gift card. Take the survey here.
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About Denise

I began working with family caregivers in 1990 and launched CareGiving.com in 1996 to help and support them. Through my blog, I share words of comfort and offer coping strategies and tips. I also write opinion pieces about recent research, community programs and media coverage of caregiving issues. I've written several caregiving books, including "The Caregiving Years, Six Stages to a Meaningful Journey," "Take Comfort, Reflections of Hope for Caregivers" and "After Caregiving Ends, A Guide to Beginning Again." You can purchase my books and schedule a coaching call with me in our store.

2 thoughts on “The Why Behind the Feeding Tube Decision

  1. Ilene Cummings

    It is my lifelong observation (I am 80) that few people really grasp what making a commitment to easing the suffering of another, means and how deeply effective bringing even the smallest light to those who live in darkness, can make. My mother spent the last eighteen years of her life in a mental institution and I watched as my father brought her cherry Life Savors, rubber bands, Camel cigarettes, and roast beef sandwiches ever Sunday for 18 years! What heroism I was privileged to witness.

    Reply
  2. eileen

    As an RN for 35+ years, I like the advice to ask the nurse. She/he is much more likely to give you the time you need to learn about the issue, as well as “straight talk” about the nuts and bolts of living with the feeding tube. Ask yourself if the feeding tube is really palliative and how much time your loved one should continue with reduced quality of life. Most nurses will tell you that a feeding tube for advanced dementia patients merely delays the inevitable.

    Reply

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