Physicians' attitudes toward tube feeding chronically ill nursing home patients

Abstract

Objective: To determine attitudes of physicians toward the limitation of tube feeding in chronically ill nursing home patients and the influences of patient preferences and other patient and physician variables on these decisions.

Design: Questionnaire-based, mailed survey. Hypothetical case scenarios derived by fractional factorial design to determine the influences of patient and family preferences, age, life expectancy, physical and cognitive functioning; direct scaling to determine the influences of legal and cost considerations.

Participants: Randomly selected national samples of American Geriatrics Society and American Medical Association members (n = 141, participation rate 41%).

Main results: Nearly all physicians indicated they would withhold (95%) or withdraw (92%) tube feeding in at least one of the 16 scenarios studied. Physician decisions were most highly associated with patient preferences, followed by family preferences, life expectancy, and cognitive status (p less than 0.02 to less than 0.001). When patients and families agreed, physicians concurred in 87% to 95% of the decisions. However, when patients and families disagreed, physicians concurred with patients in only 48% to 55% of the decisions. Increasing physician concern regarding legal and cost considerations was significantly associated with significantly higher and lower likelihoods of tube feeding, respectively (p less than 0.05).

Conclusions: These results suggest that the majority of study physicians are willing to limit tube feeding in nursing home patients under some circumstances. Patient preferences appear to be the most important factor in these decisions, but may not be honored, especially if the wishes of patients and their families are not in concurrence.