Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld or withdrawn in patients with advanced dementia or other near end-of-life conditions, according to a special report published today in the OnlineFirst version of Nutrition in Clinical Practice (NCP), the official journal of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.).
Written by the International Clinical Ethics Section of A.S.P.E.N., the report suggests that advanced dementia be seen by health care providers as a terminal illness. And that view and what it means should be communicated to the patient's family and loved ones for patient-centered care decision making.
The report states, "Numerous articles have been published about advanced dementia and use of feeding tubes, yet there remains a high consistency in finding a lack of efficacy in tube feeding in this population. Current scientific evidence suggests that the potential benefits of tube feeding do not outweigh the associated burdens of treatment in persons with advanced dementia. Studies consistently demonstrate a very high mortality rate in older adults with advanced dementia who have feeding tubes."
Based on its findings, the authors conclude that a thorough discussion should take place with the patient, family, significant others, caregivers, and/or surrogate decision makers, touching on the risks, burdens, and benefits, as well as the most updated evidence-based findings. They also stress that the final informed decision should be reached by all members of the healthcare team using a patient-centered approach, which respects the patient's autonomy, self-determination and dignity. Recognizing the role health care institutions play in end-of-life planning, the authors of the report recommend that hospitals and long-term care facilities develop a process to promote advance directives to provide health care based on the patient's wishes and best interest.
While the report focuses on patients with advanced dementia or near end of life conditions, the authors of the report believe the findings may be applicable to other patients if used in conjunction with scientific information about that defined patient population.
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Nutrition in Clinical Practice (NCP) is a peer-reviewed, interdisciplinary journal that publishes articles about the scientific basis and clinical application of nutrition and nutrition support. NCP contains comprehensive reviews, clinical research, case observations, and other types of papers written by experts in the field of nutrition and health care practitioners involved in the delivery of specialized nutrition support. NCP is an official journal of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). All published NCP articles are available online at http://ncp.sagepub.com.
The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) is dedicated to improving patient care by advancing the science and practice of nutrition support therapy and metabolism. Founded in 1976, A.S.P.E.N. is an interdisciplinary organization whose members are involved in the provision of clinical nutrition therapies, including parenteral and enteral nutrition. With more than 6,000 members from around the world, A.S.P.E.N. is a community of dietitians, nurses, nurse practitioners, pharmacists, physicians, scientists, students, and other health professionals from every facet of nutrition support clinical practice, research, and education. For more information about A.S.P.E.N., please visit http://www.nutritioncare.org.
Journal
Nutrition in Clinical Practice