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