title: Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial.
abstract: OBJECTIVE
  To test whether a decision aid improves quality of decision-making about feeding options in advanced dementia.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  Twenty-four nursing homes in North Carolina.
  
  
  METHODS
  Residents with advanced dementia and feeding problems and their surrogates.
  
  
  METHODS
  Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.affiliation: Division of Geriatric Medicine, University of North Carolina, Chapel Hill, NC, USA. lhanson@med.unc.edu
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Caprio
authors.forename: Tae Joon
authors.initials: TJ
authors.lastname: Lee
authors.forename: Mary
authors.initials: M
authors.lastname: Ersek
authors.forename: Joanne
authors.initials: J
authors.lastname: Garrett
authors.forename: Anne
authors.initials: A
authors.lastname: Jackman
authors.forename: Robin
authors.initials: R
authors.lastname: Gilliam
authors.forename: Kathryn
authors.initials: K
authors.lastname: Wessell
authors.forename: Susan L
authors.initials: SL
authors.lastname: Mitchell
mesh_terms: D003657:Decision Making; D003704:Dementia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D005248:Feeding Methods; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D009735:Nursing Homes; D015995:Prevalence; D012720:Severity of Illness Index; D016896:Treatment Outcome
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