Complex Decisions Involving Gastrostomy Feeding Tubes: When You’re Never Right or Wrong Clinical decision-making in most cases of dysphagia is neither black nor white. Risk factors predisposing a person to pneumonia, malnutrition, or dehydration can never be reduced to zero chance. Clinicians often believe that patients they consider as “unsafe for oral intake” will somehow have the best outcome if they eliminate ... Article
Article  |   December 01, 2010
Complex Decisions Involving Gastrostomy Feeding Tubes: When You’re Never Right or Wrong
Author Affiliations & Notes
  • Paula Leslie
    University of Pittsburgh, Pittsburgh, PA
  • James Coyle
    Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
Article Information
Swallowing, Dysphagia & Feeding Disorders / Older Adults & Aging / Articles
Article   |   December 01, 2010
Complex Decisions Involving Gastrostomy Feeding Tubes: When You’re Never Right or Wrong
SIG 15 Perspectives on Gerontology, December 2010, Vol. 15, 42-47. doi:10.1044/gero15.2.42
SIG 15 Perspectives on Gerontology, December 2010, Vol. 15, 42-47. doi:10.1044/gero15.2.42

Clinical decision-making in most cases of dysphagia is neither black nor white. Risk factors predisposing a person to pneumonia, malnutrition, or dehydration can never be reduced to zero chance. Clinicians often believe that patients they consider as “unsafe for oral intake” will somehow have the best outcome if they eliminate aspiration while swallowing by using a feeding tube. In many cases, there is no evidence or reasonable expectation that a feeding tube will maintain or improve the patient's quality of life, health, or life expectancy. Feeding tubes can increase discomfort, worsen outcomes, or result in earlier mortality. Clinical decisions must integrate best clinical judgment, patient values and expectations, and best external evidence of a patient's whole health status not just dysphagia. We must carefully consider ethical imperatives governing health care practice, especially when a feeding tube is a possible intervention choice.

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