Surrogate decision makers' attitudes towards tube feeding in the nursing home

In the nursing home, a widely accepted medical practice is to recommend the initiation of long term tube feeding in residents with eating difficulties . However, frequently the nursing home resident has dementia, lacks decisio n-making capacity, and has no advance directives to guide the physician and the family member(s). Therefore, the family member or another surrogate de cision maker has to make the difficult decision of whether or not to consen t to the placement of a feeding tube. We surveyed 50 English speaking surro gates of nursing home residents who were on a feeding tube for at least 6 m onths. Each surrogate was contacted by telephone and was administered a 16- item structured questionnaire. Statistical analyses included frequency dist ributions, and the Wilcoxon signed rank test for two related samples. Most surrogates rated the residents' quality of life as poor or extremely poor. Yet, 78% of the surrogates perceived tube feeding to be beneficial, 62% wou ld repeat their initial decision to initiate tube feeding, and 68% would no t consider removal of the feeding tube. Their leading concerns were medical complications, tube feeding's impact on each resident's quality of life, a nd adequacy of nursing care. The surrogates were satisfied with their initi al decision for the placement of a feeding tube despite their perception th at there was no improvement in the quality of life of the residents. The su rrogates may have viewed tube feeding as a life prolonging measure. (C) 200 1 Elsevier Science Ireland Ltd. All rights reserved.