title: Gastrostomy tube placement in patients with advanced dementia or near end of life.
abstract: Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld in patients with advanced dementia or other near end-of-life conditions. In many instances healthcare providers are not optimally equipped to implement this recommendation at the bedside. Autonomy of the patient or surrogate decision maker should be respected, as should the patient's cultural, religious, social, and emotional value system. Clinical practice needs to address risks, burdens, benefits, and expected short-term and long-term outcomes in order to clarify practice changes. This paper recommends a change in clinical practice and care strategy based on the results of a thorough literature review and provides tools for healthcare clinicians, particularly in the hospital setting, including an algorithm for decision making and a checklist to use prior to the placement of G-tubes or other long-term enteral access devices. Integrating concepts of patient-centered care, shared decision making, health literacy, and the teach-back method of education enhances the desired outcome of ethical dilemma prevention. The goal is advance care planning and a timely consensus among health team members, family members, and significant others regarding end-of-life care for patients who do not have an advance directive and lack the capacity to advocate for themselves. Achieving this goal requires interdisciplinary collaboration and proactive planning within a supportive healthcare institution environment.
authors.affiliation: Providence Saint Joseph Medical Center, Burbank, California denisebairdschwartz@gmail.com.
authors.forename: Denise Baird
authors.initials: DB
authors.lastname: Schwartz
authors.affiliation: Atlanta Medical Center, Atlanta, Georgia.
authors.forename: Albert
authors.initials: A
authors.lastname: Barrocas
authors.affiliation: Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois.
authors.forename: John R
authors.initials: JR
authors.lastname: Wesley
authors.affiliation: Clinical Nutrition Service and Nutrition Support Unit, Austral University Hospital, Buenos Aires, Argentina.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Kliger
authors.affiliation: Christus University School of Medicine, Fortaleza, Ceara, Brazil Baxter Healthcare, Singapore, Singapore.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pontes-Arruda
authors.affiliation: Intestinal Failure Unit, Sanvite, Zapopan, Mexico.
authors.forename: Humberto Arenas
authors.initials: HA
authors.lastname: Márquez
authors.affiliation: Martin Health System, Stuart, Florida.
authors.forename: Rosemarie Lembo
authors.initials: RL
authors.lastname: James
authors.affiliation: West Chester University of Pennsylvania, West Chester, Pennsylvania.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Monturo
authors.affiliation: Nutrition Support Consultant, Chicago, Illinois.
authors.forename: Lucinda K
authors.initials: LK
authors.lastname: Lysen
authors.affiliation: Veterans Affairs Boston Healthcare System-West Roxbury Campus, Boston, Massachusetts.
authors.forename: Angela
authors.initials: A
authors.lastname: DiTucci
mesh_terms: D000465:Algorithms; D001291:Attitude of Health Personnel; D057189:Checklist; D032921:Consensus; D000075202:Contraindications; D003657:Decision Making; D003704:Dementia / Q000503:physiopathology*; D004046:Dietetics / Q000592:standards; D004750:Enteral Nutrition / Q000592:standards; D019317:Evidence-Based Medicine; D005190:Family; D005774:Gastrostomy; D006801:Humans; D018802:Patient-Centered Care; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index; D012958:Societies, Scientific; D013727:Terminal Care / Q000592:standards; D014481:United States; D000078329:Workforce
keywords: aged; dementia; enteral nutrition; ethics; nutritional support; terminal care