caa a22 4500 469050691 CHVBK 20180323132829.0 cr unu---uuuuu 170328e19920601xx s 000 0 eng 10.1007/BF02493435 doi (NATIONALLICENCE)springer-10.1007/BF02493435 Quill Timothy Department of Medicine, The Genesee Hospital, 224 Alexander St., 14607, Rochester, NY, USA aut Utilization of Nasogastric feeding tubes in a group of chronically Ill, Elderly patients in a community hospital [Elektronische Daten] [Timothy Quill] Physician practice patterns and attitudes about the use of nasogastric (NG) feeding tubes in a group of elderly patients with severe chronic illness were explored in a community-based teaching hospital in Rochester, NY, using a physician questionnaire and a chart review. The physician questionnaire showed considerable divergence in beliefs about whether this treatment is extraordinary (42%), ordinary (21%), or comfort oriented (37%). Physicians who believed it was extraordinary treatment said they would recommend it less often than those who believed it to be ordinary or comfort oriented in the abstract scenario of a chronically ill, elderly patient who was not maintaining adequate nutrition. Most physician-respondents believed that the patient's wishes should guide the decision. Independently, Medical records were retrospectively reviewed for all patients admitted to the hospital in the previous year who had an NG feeding tube placed, who were over the age of 70 years, and who had primary diagnoses of cerebrovascular accident, organic brain syndrome, or metastatic cancer. Contrary to the questionnaire responses, oral or written consent was documented in only 2 of 51 insertions of NG tubes. Of the 7 charts where a surrogate gave consent, only one expressed consideration of the patient's actual wishes. The clinical reasoning leading to the decision documented in the chart emphasized biomedical concerns much more than the patient's quality of life (8∶1 ratio). Sixty-four percent (35/55) of patients in the study group died in the hospital, including 90% (19/21) of those who were to be treated with a comfort orientation. In only 2 of 55 patients was medical improvement cited as the reason for discontinuing use of the NG feeding tube. Restraints were used in 53% of the patients to keep the tube in. Recommendations are made that emphasize the need for active patient and family participation in the decision to use an NG feeding tube, requiring a balanced presentation of potential benefits, burdens, and limitations in patients with severe irreversible illnesses. Springer-Verlag New York Inc, 1992 Enteral hyperalimentation nationallicence Terminal illness nationallicence Medical decision making nationallicence Deglutition nationallicence Deglutition disorders nationallicence Do-Not-Resuscitate nationallicence Dysphagia Springer-Verlag 7/2(1992-06-01), 64-70 0179-051X 7:2<64 1992 7 455 https://doi.org/10.1007/BF02493435 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF02493435 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Quill Timothy Department of Medicine, The Genesee Hospital, 224 Alexander St., 14607, Rochester, NY, USA aut NATIONALLICENCE 773 0- Dysphagia Springer-Verlag 7/2(1992-06-01), 64-70 0179-051X 7:2<64 1992 7 455 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer