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Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial
Laura C Hanson1, Timothy S Carey, Anthony J Caprio
1Division of Geriatric Medicine, University of North Carolina, Chapel Hill, NC, USA. lhanson@med.unc.edu
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.
