SURROGATE DECISION-MAKERS SATISFACTION WITH THE PLACEMENT OF FEEDING TUBES IN ELDERLY PATIENTS

Objective: To assess the satisfaction of surrogate decisionmakers with the decision to place feeding tubes in elderly patients with impaired decision-making capacity. Design: Inception cohort followed for 5 weeks. Setting: Four hospitals in the greater Los Angeles area. Participants: 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. Measurements: 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. Results: 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. Conclusions: 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.