GASTRIC FEEDING TUBES: PATIENT/FAMILY/PROVIDER VIEWS

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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.