The adequacy of informed consent for placement of gastrostomy tubes.
BACKGROUND
Gastrostomy tubes are placed commonly in patients with limited life expectancy. However, it is unclear whether the process of informed consent is adequate in these patients. This study examined the quality of informed consent in hospitalized patients undergoing placement of gastrostomy tubes.


METHODS
Retrospective review of the medical records of a cohort of 154 consecutive hospitalized adults undergoing placement of gastrostomy tubes in the context of chronic progressive illness, in the setting of a large community-teaching hospital.


RESULTS
The medical record documented a procedure-specific discussion of benefits and burdens of and alternatives to tube feeding in only 1 of 154 patients. Only 12 of 33 definitely or probably competent patients signed the hospital consent form; in the remaining 21, a surrogate decision-maker signed the form. The cumulative 1-year mortality for this cohort was 50%.


CONCLUSIONS
The quality of informed consent for placement of gastrostomy tubes was inadequate in a large community-teaching hospital. Indirect evidence from the literature suggests that these results are not unique to this institution. Physicians should become more familiar with the medical and ethical issues relevant to medically administered nutrition near the end of life, and institutions should develop procedures to improve the quality of decision-making for patients considering this intervention.
Brett
A S
AS
Department of Medicine, University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC 29203, USA. allansb@medpark.sc.edu
Rosenberg
J C
JC
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004750:Enteral Nutrition; D004992:Ethics, Medical; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000523:psychology; D006801:Humans; D007258:Informed Consent / Q000706:statistics & numerical data*; D008017:Life Expectancy; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D010819:Physician's Role; D011787:Quality of Health Care; D018570:Risk Assessment; D019452:Terminally Ill; D020458:Third-Party Consent / Q000706:statistics & numerical data