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

决策辅助工具的开发渥太华健康研究所设计的管饲决策辅助工具是专门为替代决策者准备的，这些决策者必须决定是否允许将PEG管放置在65岁或65岁以上无法独立进食的认知障碍患者中。决策辅助工具包含有关以下方面的信息：认知障碍老年人进食和吞咽问题的常见原因，PEG管放置和使用的技术考虑，替代决策的原则，管饲的风险和益处，支持性护理的选择，以及如果替代品决策者选择干预，关于未来停止PEG管喂养的一些考虑。本研究将管饲决策辅助手册翻译成日语。对决策辅助工具的评价研究前/后对管饲决策辅助工具进行了评价。参与者是13名65岁及以上的认知障碍住院患者的替代决策者，这些患者正在日本的急性护理医院和混合护理医院考虑放置PEG管。研究人员使用问卷来比较替代决策者的知识，决策冲突，以及暴露于决策辅助之前和之后关于饲管放置的倾向。还评估了决策辅助的可接受性。采用配对t检验比较使用决策辅助工具前后受试者的知识和决策冲突得分。使用决策辅助工具后，替代决策者对长期管饲的知识显著增加（P<. 001），决策冲突显著减少（P<. 001）。所有替代决策者都认为决策辅助工具很有帮助，并且可以接受

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