Royal College of Surgeons, Dublin, Ireland.
Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
J Am Geriatr Soc. 2020 Oct;68(10):2264-2269. doi: 10.1111/jgs.16641. Epub 2020 Jun 19.
Evidence suggests that tube feeding persons with severe dementia (PWSDs) does not improve survival or quality of life, yet many continue to be tube fed. Reasons why caregivers choose to do so are not entirely understood.
To understand what shapes caregiver preference toward nasogastric (NG) tube feeding for community-dwelling PWSDs.
A qualitative study that employed semistructured interviews.
Primary informal caregivers of community-dwelling persons diagnosed with dementia Functional Assessment Staging Test (FAST) stage 7 in Singapore.
Caregivers participated in qualitative in-depth interviews during which their preferences toward NG tube feeding of PWSDs were explored. We used principles of reflexive thematic analysis to compare caregivers who expressed a preference for NG tube feeding with those who did not prefer it.
We interviewed 27 caregivers of PWSDs. Most caregivers, 67% (n = 18), expressed a preference for tube feeding. We conceptualized four main themes describing what shapes caregiver preference toward NG tube feeding: (1) willingness to use tube feeding to prolong life at the expense of suffering, (2) deference to healthcare provider's (HCP's) recommendation, (3) caregiver knowledge of alternatives to tube feeding, and (4) caregivers' internal and external conflicts.
Results from this study highlight the need for new inclusive approaches to shared decision-making between HCPs and caregivers regarding tube feeding for community-dwelling PWSDs. J Am Geriatr Soc 68:2264-2269, 2020.
有证据表明，对患有严重痴呆症（PWSD）的患者进行管饲并不能提高其生存率或生活质量，但仍有许多患者在接受管饲。至于为什么护理人员选择这样做，其原因尚未完全清楚。
了解护理人员对社区居住的 PWSD 进行鼻胃（NG）管饲的偏好的原因。
采用半结构式访谈的定性研究。
新加坡，对社区居住且被诊断为痴呆症的功能评估分期测试（FAST）第 7 期的患者的主要非正式护理人员。
护理人员参加了定性深入访谈，探讨了他们对 PWSD NG 管饲的偏好。我们使用反思性主题分析的原则，比较了表达对 NG 管饲偏好的护理人员和不喜欢 NG 管饲的护理人员。
我们采访了 27 名 PWSD 的护理人员。大多数护理人员（67%，n=18）表示他们对管饲有偏好。我们提出了四个主要主题，描述了影响护理人员对 NG 管饲偏好的因素：（1）愿意通过管饲来延长生命，不惜牺牲痛苦；（2）听从医疗保健提供者（HCP）的建议；（3）护理人员对管饲替代方案的了解；（4）护理人员的内心冲突和外部压力。
本研究的结果强调需要采用新的综合方法，在社区居住的 PWSD 进行管饲治疗方面，促进 HCP 与护理人员之间的共同决策。美国老年学会杂志 68:2264-2269，2020。
