Gastronomy tube placement or other long-term enteral access devices should be withheld or withdrawn in patients with advanced dementia or other near end-of-life conditions. A special report published today in the OnlineFirst version of Nutrition in Clinical Practice (NCP), the official journal of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) has recommended this based on current scientific literature.
Written by the International Clinical Ethics Section of A.S.P.E.N., the report suggests that advanced dementia be seen by health care providers as a terminal illness. And that view and what it means should be communicated to the patient's family and loved ones for patient-centered care decision making.
The report states, "Numerous articles have been published about advanced dementia and use of feeding tubes, yet there remains a high consistency in finding a lack of efficacy in tube feeding in this population. Current scientific evidence suggests that the potential benefits of tube feeding do not outweigh the associated burdens of treatment in persons with advanced dementia. Studies consistently demonstrate a very high mortality rate in older adults with advanced dementia who have feeding tubes."
Based on its findings, the authors conclude that a thorough discussion should take place with the patient, family, significant others, caregivers, and/or surrogate decision makers, touching on the risks, burdens, and benefits, as well as the most updated evidence-based findings. They also stress that the final informed decision should be reached by all members of the healthcare team using a patient-centered approach, which respects the patient's autonomy, self-determination and dignity. Recognizing the role health care institutions play in end-of-life planning, the authors of the report recommend that hospitals and long-term care facilities develop a process to promote advance directives to provide health care based on the patient's wishes and best interest.
While the report focuses on patients with advanced dementia or near end of life conditions, the authors of the report believe the findings may be applicable to other patients if used in conjunction with scientific information about that defined patient population.