McNabney M K, Beers M H, Siebens H
UCLA School of Medicine.
J Am Geriatr Soc. 1994 Feb;42(2):161-8. doi: 10.1111/j.1532-5415.1994.tb04946.x.
To assess the satisfaction of surrogate decision-makers with the decision to place feeding tubes in elderly patients with impaired decision-making capacity.
Inception cohort followed for 5 weeks.
Four hospitals in the greater Los Angeles area.
Fifty-eight surrogate decision-makers for elderly patients (over 60) who recently received a first-time percutaneous endoscopic gastrostomy. Participants were identified through the endoscopy departments at the four hospitals.
We surveyed surrogates by telephone within 5 days of placement for background data and after 5 weeks of use to assess satisfaction with the decision. The main outcome variables at follow-up were: surrogate satisfaction; whether the surrogate would repeat the decision; whether the surrogate had considered removal of the tube; and surrogates' perception of patients preference for the tube.
After 5 weeks of use, 84% of surrogates stated that they would repeat the decision. Fifty-nine percent of surrogates described themselves as satisfied with the decision, and 17% were dissatisfied. Only 10% had considered removing the tube. After 5 weeks of use, 36% of surrogates felt that the patient would prefer the tube, and 31% felt they would not.
Most surrogates we studied would repeat the decision to have a feeding tube after experiencing its effects for 5 weeks. However, almost one-third felt the patient would not want the tube. Physicians and surrogates may need to place greater emphasis on patients' wishes before placing feeding tubes and when reassessing their benefit to the patient after being placed.
评估替代决策者对为决策能力受损的老年患者放置饲管这一决定的满意度。
起始队列随访5周。
大洛杉矶地区的四家医院。
58名老年患者（60岁以上）的替代决策者，这些患者最近首次接受经皮内镜下胃造口术。参与者通过四家医院的内镜科确定。
我们在放置饲管后5天内通过电话调查替代决策者以获取背景数据，并在使用5周后评估他们对该决定的满意度。随访时的主要结局变量为：替代决策者的满意度；替代决策者是否会再次做出相同决定；替代决策者是否曾考虑移除饲管；以及替代决策者对患者对饲管偏好的看法。
使用5周后，84%的替代决策者表示他们会再次做出相同决定。59%的替代决策者称对该决定感到满意，17%表示不满意。只有10%曾考虑移除饲管。使用5周后，36%的替代决策者认为患者会希望保留饲管，31%认为患者不会希望保留。
我们研究的大多数替代决策者在体验饲管使用效果5周后会再次做出放置饲管的决定。然而，近三分之一的人认为患者不希望保留饲管。医生和替代决策者在放置饲管前以及放置后重新评估其对患者的益处时，可能需要更加强调患者的意愿。
