A decision aid for long-term tube feeding in cognitively impaired older persons

OBJECTIVE: To describe the development and evaluation of a decision aid for long-term tube feeding in cognitively impaired older people. DESIGN: Before-and-after study. SETTING: Acute care hospitals in Ottawa, Canada. PARTICIPANTS: Substitute decision makers for 15 cognitively impaired inpatients 65 years and older being considered for placement of a percutaneous endoscopic gastrostomy tube. MEASUREMENTS: Questionnaires were used to compare the substitute decision makers' knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the decision aid. The acceptability of the decision aid was also assessed. RESULTS: Substitute decision makers significantly increased their knowledge (P = .004) and decreased their decisional conflict (P = .004) regarding long-term tube feeding after using the decision aid. The impact of the decision aid on predisposition toward the intervention was greatest for those who were unsure of their preferences at baseline. All substitute decision makers found the decision aid helpful and acceptable despite very difficult and emotional circumstances. CONCLUSIONS: A decision aid improves the decisionmaking process for long-term tube feeding in cognitively impaired older patients by decreasing decisional conflict and by promoting decisions that are informed and consistent with personal values. There are particular challenges for developing and evaluating these tools in the context of end-of-life decisions.