American Journal of Speech-Language Pathology Vol.18 222-230 August 2009. doi:10.1044/1058-0360(2008/08-0013)
© American Speech-Language-Hearing Association
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Research

Feeding Tube Placement in Patients With Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists

Helen M. Sharp
Western Michigan University, Kalamazoo

Joseph W. Shega
Northwestern University, Chicago

Contact author: Helen M. Sharp, Western Michigan University, 1903 West Michigan Avenue, Mail Stop #5355, Kalamazoo, MI 49008. E-mail: helen.sharp{at}wmich.edu.

Purpose: To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia.

Method: A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs.

Results: The response rate was 57%, and 326 surveys met inclusion criteria. Fifty-six percent of SLPs recommended PEG for a patient with advanced dementia and dysphagia. Contrary to the evidence, many respondents believed that PEG improves nutritional status and increases survival. Relatively few SLPs believed that PEG improved patients' functional status or quality of life. Patient factors (e.g., age or prognosis) were more often identified as influences on recommendations for PEG than were extrinsic factors (e.g., cost). Nearly 40% believed that PEG was the standard of care, while 15% believed it should be. Very few SLPs (11%) would want a PEG themselves. Perceived standard of care was significantly related to both geographic region and population density (p < .05), but self-reported practices were not.

Conclusions: Discrepancies between SLPs' beliefs, the literature, and self-reported practices were observed. The findings suggest the need to connect the evidence base to clinical practice and to include SLPs in local and national discussions about end-of-life care protocols.

Key Words: nutrition and hydration, ethics, end-of-life care, quality of life, professional practices


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