2012 Fiscal Year Final Research Report

A Decision Aid for Long-Term Tube Feeding in Cognitively Impaired Older Persons in Japa

Research Project

Project/Area Number	22890189
Research Category	Grant-in-Aid for Research Activity Start-up
Allocation Type	Single-year Grants
Research Field	Fundamental nursing
Research Institution	St. Luke's College of Nursing
Principal Investigator	KURAOKA Yumiko 聖路加看護大学, 看護学部, 助教 (30584429)
Project Period (FY)	2010 – 2012
Keywords	胃瘻 / 経管栄養 / 意思決定支援 / 家族
Research Abstract	Development of the Decision AidA tube feeding decision aid designed at the Ottawa Health Research Institute was specifically prepared for substitute decision makers who must decide whether to allow placement of a PEG tube in a cognitively impaired person 65 years or older who is unable to eat independently. The decision aid contains information about the following areas: common causes of eating and swallowing problems in older persons with cognitive impairment, technical considerations regarding the placement and use of PEG tubes, principles of substitute decision-making, the risks and benefits of tube feeding, the option of supportive care, and some considerations regarding future discontinuation of PEG tube feeding if the substitute decision maker opts for the intervention. The tube feeding decision aid booklet was translated into Japanese.Evaluation of the Decision AidA before/after study was conducted to evaluate the tube feeding decision aid.Participants is substitute decision makers for 13 cognitively impaired inpatients 65 years and older being considered for placement of a PEG tube in Acute care hospitals and mixed care hospitals in Japan. Questionnaires were used to compare the substitute decision maker’s knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to the decision aid. The acceptability of the decision aid was also assessed. Paired t-tests were used to compare subject’ s knowledge and decisional conflict scores before and after using the decision aids.Substitute decision makers significantly increased their knowledge (P<.001) and decreased their decisional conflict (P<.001) regarding long-term tube feeding after using the decision aid. All substitute decision makers found the decision aid helpful and acceptable