Modeling decisions to use tube feeding in seriously ill patients.

Clinical decisions to use life-sustaining technologies, such as tube feeding in seriously ill patients, depend on many important factors. Using case simulations, we analyzed the decisions of students, housestaff, and faculty of Temple University School of Medicine, Philadelphia, to use tube feeding in seriously ill patients. Although patient preference was the most important factor for most respondents, we observed three different patterns of decision strategies. Those in the first group, the autonomists (34% of respondents), considered only patient preference; those in the second group, the mixed strategists (56% of respondents), included patient preference among other important factors; and those in the third group, the paternalists (10% of respondents), used factors other than patient preference. More experienced clinicians and those individuals who believed tube feeding represented an extraordinary level of care were significantly less likely to begin tube feeding in the case simulations. Description of these individual decision strategies and elucidation of the important physician characteristics can help identify the potential ethical dilemmas in these different clinical decisions.