GASTRIC FEEDING TUBES: PATIENT/FAMILY/PROVIDER VIEWS

我们提出了一项为期两年半的前瞻性研究，对象主要是患有神经系统疾病、头颈癌和接受胃管喂养的严重内科疾病的老年患者。我们希望从患者和照顾者的角度来定义这种治疗的结果。用于医疗保险人群的胃造口管数量迅速增长，在过去十年中翻了一番以上。导致吞咽困难的疾病还会缩短预期寿命，并导致认知、身体和社会功能的其他缺陷。营养、水分和饮食的社会背景是这些患者临终时舒适护理的基本要素。喂养是给予护理和养育的主要行为，但试管喂养已经成为一种对患者和照顾者充满伦理影响的维持生命的治疗形式。以前的研究强调了这一过程的医学结果。以前没有研究从患者和照顾者的角度检查这种治疗的结果。我们的总体目标是：1.描述患者、家庭、医疗保健提供者对胃喂养管在以下方面的益处的期望：患者寿命、患者功能、因肺炎住院的可能性。2.从患者、家属和医护人员(包括医生和护士)的角度，比较放置胃管时的感知益处与随访3个月和6个月时的生存结果、功能状态和肺炎等感知益处。3.描述插管后存活3个月和6个月的患者的真实生存结果、肺炎发生率和功能状态。我们将从北卡罗来纳州的两家医院招募200名胃造口术患者：一家大学三级护理中心和一家大型社区医院。手术后不久将与医生、护士、家庭照顾者和患者进行访谈，并在3个月和6个月时进行后续访谈。访谈将包括对功能状态、感知益处以及对寿命和未来功能的期望的评估。这些关于胃造瘘管使用的多角度将使人们能够更全面地了解这种越来越多地使用的支持性疗法在生命末期的好处和局限性。

We propose a two and a half year prospective study of predominantly older individuals with neurologic diseases, head and neck cancer, and severe medical illness who receive gastric feeding tubes. We wish to define the outcomes of this treatment from a patient and caregiver perspectives. The number of gastrostomy feeding tubes used for the Medicare population has grown rapidly, more than doubling during the past decade. The diseases that cause dysphagia also shorten life expectancy, and cause other deficits in cognitive, physical and social functioning. Nutrition, hydration, and the social context of eating are fundamental elements of comfort care for these patients near the end of life. Feeding is a primary act of care giving and nurture, yet tube feedings have become a form of life- sustaining treatment fraught with ethical implications for patients and caregivers. Previous studies have emphasized medical outcomes of this procedure. No prior study has examined outcomes of this treatment from the patient and caregiver perspective. Our overall aims are: 1. Describe the expectations of patient, family, health care providers regarding the benefits of gastric feeding tubes on: patient longevity, patient functioning, likelihood of hospitalization for pneumonia. 2. Compare perceived benefits of gastric feeding tubes at the time of placement to perceived benefits such as outcomes of survival, functional status and pneumonia at 3 and 6 month follow-up, from the perspectives of patient, family and health care providers, including physicians and nurses. 3. Describe the true outcomes of patient survival, pneumonia incidence and functional status among those who survive for 3 and 6 months after insertion of the feeding tube. We will recruit 200 patients receiving gastrostomy from two North Carolina hospitals: a university tertiary care center, and a large community hospital. Interviews will be conducted with physicians, nurses, family caregivers and patients shortly following the procedure with follow-up interviews at 3 and 6 months. The interview will include assessment of functional status, perceived benefit, and expectations regarding longevity and future function. These multiple perspectives on the use of gastrostomy tubes will allow a much more complete portrait of the benefits and limitations of this increasingly utilized supportive therapy at the end of life.