A Decision Aid for Long-Term Tube Feeding in Cognitively Impaired Older Persons in Japa

渥太华健康研究所设计的Decision AidA管饲决策辅助工具的开发是专门为必须决定是否允许在65岁或以上不能独立进食的认知障碍患者中放置PEG管的替代决策者准备的。决策辅助包含以下方面的信息：认知障碍老年人进食和吞咽问题的常见原因，关于放置和使用PEG管的技术考虑因素，替代决策原则，管饲的风险和益处，支持护理的选择，以及如果替代决策者选择干预，关于未来停止PEG管饲的一些考虑因素。管饲决策辅助手册被翻译成日文。在研究前后进行决策辅助评价，对管饲决策辅助进行评价。参与者是日本急性护理医院和混合护理医院考虑放置PEG管的13名65岁及以上认知障碍住院患者的替代决策者。采用问卷调查的方法比较了辅助决策工具出现前后替代决策者对饲管放置的认知、决策冲突和倾向。还评估了决策援助的可接受性。采用配对t检验比较使用辅助决策工具前后被试的知识和决策冲突得分。使用辅助决策工具后，替代决策者对长期管饲的认知显著增加（P< 0.001），决策冲突显著减少（P< 0.001）。所有替代决策者都认为决策辅助工具是有用和可接受的

Development of the Decision AidA tube feeding decision aid designed at the Ottawa Health Research Institute was specifically prepared for substitute decision makers who must decide whether to allow placement of a PEG tube in a cognitively impaired person 65 years or older who is unable to eat independently. The decision aid contains information about the following areas: common causes of eating and swallowing problems in older persons with cognitive impairment, technical considerations regarding the placement and use of PEG tubes, principles of substitute decision-making, the risks and benefits of tube feeding, the option of supportive care, and some considerations regarding future discontinuation of PEG tube feeding if the substitute decision maker opts for the intervention. The tube feeding decision aid booklet was translated into Japanese.Evaluation of the Decision AidA before/after study was conducted to evaluate the tube feeding decision aid.Participants is substitute decision makers for 13 cognitively impaired inpatients 65 years and older being considered for placement of a PEG tube in Acute care hospitals and mixed care hospitals in Japan. Questionnaires were used to compare the substitute decision maker’s 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. Paired t-tests were used to compare subject’ s knowledge and decisional conflict scores before and after using the decision aids.Substitute decision makers significantly increased their knowledge (P<.001) and decreased their decisional conflict (P<.001) regarding long-term tube feeding after using the decision aid. All substitute decision makers found the decision aid helpful and acceptable