Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

End-of-life care must reflect patient wishes and values

10.02.2010
Researchers from Brown University and Harvard Medical School are calling for improved decision-making in the use of feeding tubes for hospitalized nursing home residents with advanced dementia.

Their position follows an eight-year study, which found that the use of feeding tubes varies widely. Among their major findings: At 25 percent of the nation's acute-care hospitals, this vulnerable population had a one in 10 chance of having a feeding tube inserted. Twelve percent of acute-care hospitals did not insert a feeding tube at all.

Medical evidence has long suggested that feeding tubes do not improve survival or overall outcomes in patients with dementia, a terminal illness that affect a patient's mind and eventually the ability to eat.

Details of the study are outlined in the Feb. 10, 2010, issue of JAMA, the Journal of the American Medical Association.

"Our results suggest that decisions to insert a feeding tube in persons with advanced dementia are more about which hospital you are admitted to than a decision-making process that elicits and supports patient choice," said Dr. Joan M. Teno, lead author and professor of community health and medicine at the Warren Alpert Medical School of Brown University.

The range of feeding tube use varies widely. Researchers found the rate of feeding tube insertions per 100 hospital admissions varied from 0 to 39, depending on the hospital. On average, 6.5 out of every 100 admissions resulted in a feeding tube insertion.

Teno and the other researchers conducted their study by looking at nearly 2,800 acute-care hospitals. They sifted through Medicare claim files involving more than 280,000 admissions from 2000 to 2007 to determine the rate of feeding tube insertions among hospitalized nursing home residents over age 66 with advanced dementia. They looked at hospitals with at least 30 admissions involving nursing home residents with advanced dementia during that period.

Hospitals with a culture of aggressive care at the end of life were nearly three times more likely to insert a feeding tube, according to the study. Larger or for-profit hospitals tended to use them more. Smaller, rural hospitals not affiliated with medical schools used them far less frequently.

Second author Dr. Susan Mitchell, associate professor of medicine at Harvard Medical school, said the data points to a clear need to examine how treatment decisions are made for patients with advanced dementia.

"Our results call for acute-care hospitals to examine how decisions are made for nursing home residents with advanced dementia, to ensure the decisions reflect patient wishes and values," Mitchell said.

Still, Teno said, there should always be exceptions, particularly if the use of feeding tubes reflects a patient's religious wishes.

"If a patient has strong religious wishes that they receive every bit of life-sustaining treatment regardless of outcome, we are still a society where we have to honor those wishes," Teno said. "But we need to make sure these decisions are based on patients' wishes and values."

Teno herself keeps in mind the Oct. 15, 2008 death of her mother in mind following a stroke and then terminal illness.

"My mother requested that she not have a feeding tube inserted if she became terminally ill," Teno said. "What informed my mom's care was her wishes and values, and I want our health care system to ensure that these important decisions consider the values and wishes of that dying patient. As we reform our health care system, incentives that ensure patient choice are key.

To that end, the research teams will publish hospital rates of feeding tube insertions for persons with advanced dementia on its Web site, LTCFocUS.org.

Teno worked with researchers from Brown, Hebrew Senior Life (affiliated with Harvard Medical School) and the Providence Veterans Affairs Medical Center.

The research was funded as part of a grant and a program project on shaping long-term care in America funded by the National Institute on Aging and based at the Center for Gerontology and Health Care Research at Brown.

Editors: Brown University has a fiber link television studio available for domestic and international live and taped interviews, and maintains an ISDN line for radio interviews. For more information, call (401) 863-2476.

Mark Hollmer | EurekAlert!
Further information:
http://www.brown.edu

More articles from Studies and Analyses:

nachricht Smart Data Transformation – Surfing the Big Wave
02.12.2016 | Fraunhofer-Institut für Angewandte Informationstechnik FIT

nachricht Climate change could outpace EPA Lake Champlain protections
18.11.2016 | University of Vermont

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

Closing the carbon loop

08.12.2016 | Life Sciences

Applicability of dynamic facilitation theory to binary hard disk systems

08.12.2016 | Physics and Astronomy

Scientists track chemical and structural evolution of catalytic nanoparticles in 3-D

08.12.2016 | Materials Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>