OBJECTIVES: To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. DESIGN: Cluster randomized controlled trial. SETTING: Twenty-four nursing homes in North Carolina. PARTICIPANTS: Residents with advanced dementia and feeding problems and their surrogates. INTERVENTION: Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. MEASUREMENTS: Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. RESULTS:Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34). CONCLUSION: A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers.
RCT Entities:
OBJECTIVES: To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia. DESIGN: Cluster randomized controlled trial. SETTING: Twenty-four nursing homes in North Carolina. PARTICIPANTS: Residents with advanced dementia and feeding problems and their surrogates. INTERVENTION: Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. MEASUREMENTS: Primary outcome was the Decisional Conflict Scale (range: 1-5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. RESULTS: Two hundred fifty-six residents and surrogate decision-makers were recruited. Residents' average age was 85; 67% were Caucasian, and 79% were women. Surrogates' average age was 59; 67% were Caucasian, and 70% were residents' children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34). CONCLUSION: A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers.
Authors: Susan L Mitchell; Joan M Teno; Dan K Kiely; Michele L Shaffer; Richard N Jones; Holly G Prigerson; Ladislav Volicer; Jane L Givens; Mary Beth Hamel Journal: N Engl J Med Date: 2009-10-15 Impact factor: 91.245
Authors: L Volicer; B Seltzer; Y Rheaume; J Karner; M Glennon; M E Riley; P Crino Journal: J Geriatr Psychiatry Neurol Date: 1989 Oct-Dec Impact factor: 2.680
Authors: E Amanda Snyder; Anthony J Caprio; Kathryn Wessell; Feng Chang Lin; Laura C Hanson Journal: J Am Med Dir Assoc Date: 2012-12-28 Impact factor: 4.669
Authors: Seth F Einterz; Robin Gilliam; Feng Chang Lin; J Marvin McBride; Laura C Hanson Journal: J Am Med Dir Assoc Date: 2014-02-06 Impact factor: 4.669
Authors: Susan L Mitchell; Betty S Black; Mary Ersek; Laura C Hanson; Susan C Miller; Greg A Sachs; Joan M Teno; R Sean Morrison Journal: Ann Intern Med Date: 2012-01-03 Impact factor: 25.391
Authors: Laura C Hanson; Sheryl Zimmerman; Mi-Kyung Song; Feng-Chang Lin; Cherie Rosemond; Timothy S Carey; Susan L Mitchell Journal: JAMA Intern Med Date: 2017-01-01 Impact factor: 21.873
Authors: Susan C Miller; Julie C Lima; Orna Intrator; Edward Martin; Janet Bull; Laura C Hanson Journal: J Pain Symptom Manage Date: 2017-04-22 Impact factor: 3.612