Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial

Area of Science:

• Gerontology
• Bioethics
• Clinical Decision-Making

Background:

• Advanced dementia presents complex feeding challenges.
• Surrogate decision-makers often face uncertainty regarding feeding options.

Purpose of the Study:

• To evaluate if a decision aid improves the quality of decision-making for feeding options in advanced dementia patients.
• To assess the impact of a decision aid on surrogate knowledge, communication, and conflict.

Main Methods:

• Cluster randomized controlled trial conducted in 24 North Carolina nursing homes.
• Intervention group surrogates received a decision aid on feeding options; control group received usual care.
• Outcomes measured at 3 months included the Decisional Conflict Scale, surrogate knowledge, provider communication, and feeding treatment use.

Main Results:

• The decision aid improved surrogate knowledge scores (P < .001).
• Intervention surrogates reported lower decisional conflict (1.65 vs 1.90, P < .001) and increased communication with healthcare providers (46% vs 33%, P = .04).
• Residents in the intervention group were more likely to receive dysphagia diets (89% vs 76%, P = .04).

Conclusions:

• A decision aid effectively reduces decisional conflict for surrogates making feeding choices for individuals with advanced dementia.
• The decision aid enhances surrogate knowledge and promotes better communication with healthcare providers regarding feeding options.
• The intervention supports more informed decisions, potentially leading to appropriate dietary modifications.