scholarly journals Decision-making around gastrostomy tube feeding in children with neurologic impairment: Engaging effectively with families

2018 ◽  
Vol 23 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Sanjay Mahant ◽  
Eyal Cohen ◽  
Katherine E Nelson ◽  
Peter Rosenbaum
Keyword(s):  
Decision Making ◽  
Tube Feeding ◽  
Gastrostomy Tube ◽  
Neurologic Impairment

Caregiver Decisional Conflict Before and After Consultation About Gastrostomy Tube Placement

2020 ◽  
Vol 10 (10) ◽  
pp. 829-835
Author(s):  
Katherine E. Nelson ◽  
Silvana Oppedisano ◽  
Maya Laxmi Patel ◽  
Sanjay Mahant ◽  
Eyal Cohen
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Decision Aid ◽  
Tube Feeding ◽  
Decisional Conflict ◽  
Clinical Encounter ◽  
Gastrostomy Tube ◽  
Tube Placement ◽  
Before And After ◽  
Consultation Model

OBJECTIVES: Families describe decision-making about gastrostomy tube (g-tube) placement as challenging. We measured caregiver decisional conflict before and after initial g-tube consultation to evaluate the potential benefit of a decision aid and feasibility in testing it. METHODS: Families presenting for initial consultation about g-tube placement completed the decisional conflict scale (DCS) at 1 or 2 of 3 time points: before consultation, after consultation, and after viewing a video. The decision support consultation was a 2-hour structured meeting with a pediatric hospitalist, nurse practitioner, and dietitian that was focused on clarifying the indication, feasibility, safety, and family values around tube placement. The video described decision-making and lived experiences of families with tube feeding. RESULTS: We measured the decisional conflict of 61 caregivers. Preconsultation decisional conflict scores were high (mean = 38.7), but there was substantial variation between families (SD = 19.4). Baseline scores did not vary between clinically relevant subgroups. Postconsultation DCS scores were lower (17.9 and SD = 13.5 for consult alone; 12.7 and SD = 13.2 for consult with video). Three caregivers (7.7%) of families had residual decisional conflict scores >37.5, the threshold conventionally associated with decision delay. CONCLUSIONS: Measuring decisional conflict among caregivers deciding about pediatric g-tube is feasible during the clinical encounter. Residual decisional conflict after our institution’s current decision support consultation model (with or without an additional video) was low, so development of an additional structured decision aid is not warranted. Further study of preconsult DCS variability across different clinical subgroups may help identify families benefiting from additional decisional support.

Supporting Life through Tube Feeding: Factors Influencing Surrogate Decision-Making

1993 ◽  
Vol 12 (3) ◽  
pp. 298-310 ◽  
Author(s):  
Donna Wilson
Keyword(s):  
Decision Making ◽  
Tube Feeding ◽  
Surrogate Decision Making ◽  
Grand Nombre ◽  
Factors Influencing ◽  
Etude De Cas ◽  
Étude De Cas ◽  
Surrogate Decision ◽  
Professionnels De La Santé

RÉSUMÉUn grand nombre de personnes ont besoin d'une sonde au cours de la dernière étape de leur vie. Par ailleurs, la décision du maintien des fonctions vitales revient souvent à une autre partie. Lorsque les membres d'une famille sont tenus de prendre cette décision pour un patient incompétent, quels facteurs influenceront leur choix? Une étude de cas et un sondage ethnométhodologique ont révélé clairement et en détail les facteurs ayant influencé une femme devant décider si les fonctions vitales de sa mére en état d'incapacité totale et de grave débilité devaient être maintenues au moyen d'une sonde pour gavage. La décision était difficile à prendre et survenait à un moment critique. Malheureusement, les facteurs ayant eu la plus forte influence furent les suivants: a) le besoin pressant d'une décision en raison d'un décès imminent; b) une lacune quant à la connaissance des valeurs et des préférences de la mère au sujet du maintien de ses fonctions vitales au moyen d'une sonde pour gavage; c) un manque de connaissance quant à la réalité de l'alimentation par sonde; et d) la croyance que cette mesure ne prolongerait pas la vie ni la souffrance de la mère. De plus, neuf autres facteurs, moins importants, ont été déterminés. Cette étude est principalement axée sur l'amélioration de la sensibilité des professionnels de la santé vis-à-vis de l'angoisse qu'éprouvent les gens à décider de maintenir les fonctions vitales d'un proche et du mode de décision en tant que tel.

scholarly journals Button Gastrostomy Tubes for Pediatric Patients: A Tertiary Care Center Experience

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Fayza Haider ◽  
Hasan Mohamed Ali Isa ◽  
Mohamed Amin Al Awadhi ◽  
Barrak Ayoub ◽  
Ezat Bakhsh ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Neurological Disorders ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Tube Feeding ◽  
Gastrostomy Tube ◽  
Tube Insertion ◽  
Main Indication ◽  
Nasogastric Tube Feeding ◽  
Button Gastrostomy

Background and Objective. Gastrostomy tube insertion is one of the most common procedures performed as a radical choice to overcome feeding difficulty in children. This study is aimed at describing the replacement of a button tube instead of the long tube for feeding infants and children requiring gastrostomies in a tertiary care hospital. Design and Setting. This retrospective cross-sectional descriptive study was conducted between January 2009 and August 2019 at Salmaniya Medical Complex which is a tertiary health care institute in the Kingdom of Bahrain. Subjects and Methods. Both charts and electronic health records of pediatric patients between the ages of 0 and 14 years were reviewed. Data were collected including age, sex, nationality, diagnosis, surgical information (procedure center and procedure performed), complications, and follow-up. Results. Out of 34 patients who underwent gastrostomy tube insertion, 30 patients had their long tube replaced by a button gastrostomy. Majority were males (N=18, 60%). Prolonged nasogastric tube feeding was the main indication of referral (N=17, 56%) followed by feed intolerance (N=6, 17%) and gastroesophageal reflux disease (N=5, 16%). The main underlying diseases at referral were neurological impairment (N=19, 63%) and metabolic disorders (N=4, 13%). There was no significant difference between patients with neurological disorders and other diseases in terms of gender, nationality, or age. Laparotomy with gastrostomy is the main approach used (N=18, 60%). No reported complications of button tubes in 50% of the patients (N=15). Conclusions. Prolonged nasogastric tube feeding is the main indication of referral for gastrostomy tube insertion. Neurological disorders are the main diagnosis for the cases operated upon. Laparotomy with gastrostomy is the procedure of choice at our center. Majority of patients had no reported complications of button tube replacement. These children are likely to benefit from the button tube with fewer complications.

scholarly journals Between Choice, Necessity, and Comfort: Deciding on Tube Feeding in the Acute Phase After a Severe Stroke

2020 ◽  
Vol 30 (7) ◽  
pp. 1114-1124
Author(s):  
Isabel Frey ◽  
Marike E. De Boer ◽  
Leonie Dronkert ◽  
A. Jeannette Pols ◽  
Marieke C. Visser ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Acute Phase ◽  
Participant Observation ◽  
Tube Feeding ◽  
Ethnographic Study ◽  
Sources Of Information ◽  
Severe Stroke ◽  
Stroke Units ◽  
Life Sustaining Treatment

This is an ethnographic study of decision-making concerning tube feeding in the acute phase after a severe stroke. It is based on 6 months of ethnographic research in three stroke units in the Netherlands, where the decision-making on life-sustaining treatment was studied in 16 cases of severe stroke patients. Data were collected through participant observation and interviews. For this article, the analysis was narrowed down to the decision whether or not the patient should receive tube feeding. The data on tube feeding were assembled and coded according to different modes of dealing with this decision in clinical practice, which we refer to as “repertoires.” We discerned three different repertoires: choice, necessity, and comfort. Each repertoire structures clinical practice differently: It implies distinctive ethical imperatives, central concerns, sources of information, and temporalities. We hope our findings can improve decision-making by uncovering its underlying logics in clinical practice.

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