GASTRIC FEEDING TUBES: PATIENT/FAMILY/PROVIDER VIEWS

我们提出了一个为期两年半的前瞻性研究，主要是老年人与神经系统疾病，头颈癌，严重的医疗疾病谁收到胃饲管。 我们希望从患者和护理人员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术饲管数量迅速增长，在过去十年中增加了一倍多。 导致吞咽困难的疾病也会缩短预期寿命，并导致认知、身体和社会功能的其他缺陷。 营养、水合作用和饮食的社会背景是这些患者在生命末期舒适护理的基本要素。 喂养是给予照顾和养育的主要行为，然而管饲已经成为一种维持生命的治疗形式，对患者和照顾者充满了伦理意义。 以前的研究强调了这种手术的医疗结果。 以前没有研究从患者和护理人员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、家属、医疗保健提供者对胃饲管的受益的期望：患者寿命、患者功能、因肺炎住院的可能性。 2.从患者、家庭和医疗保健提供者（包括医生和护士）的角度，比较放置胃饲管时的感知受益与3个月和6个月随访时的感知受益，如生存结局、功能状态和肺炎。 3.描述插入饲管后存活3个月和6个月的患者的真实生存结局、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名接受胃造口术的患者：一家大学三级护理中心和一家大型社区医院。 将在手术后不久与医生、护士、家庭护理人员和患者进行访谈，并在3个月和6个月进行随访。 访谈将包括评估功能状态、感知获益以及对寿命和未来功能的预期。 这些关于胃造口管使用的多个观点将允许更完整地描绘这种在生命结束时越来越多地使用的支持性治疗的益处和局限性。

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.