Factors Associated with Physician Decision-Making in Starting Tube Feeding

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Abstract
Background: Because tube-feeding decisions are sometimes difficult, we examined physician, institutional, and patient factors associated with these decisions. Methods: Primary care physicians (n = 388) likely to manage nursing home patients in Hawaii were surveyed. Respondents indicated the factors of great importance in tube feeding decisions based on a vignette of a poststroke patient failing to thrive and family disagreement with advance directives. χ2 and multiple logistic regression analyses were used to examine associations between physician demographics and factors of importance to physicians and their decisions based on the vignette. Results: Starting tube feeding (chosen by 31% of respondents) was associated with internal medicine specialty (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.4–4.6), and placing great importance on family preference (OR 5.4, 95% CI 3.0–9.8) and liability (OR 2.5, 95% CI 1.3–4.8). After 3 months without improvement, 58% chose to withdraw tube feeding. Continuing tube feeding was associated with placing great importance on family wishes (OR 3.0, 95% CI 1.8–5.1) and liability (OR 1.7, 95% CI 1.0–2.9). Placing great importance on the living will was associated with decreased likelihoods of starting (OR 0.1, 95% CI 0.04–0.3) and continuing (OR 0.1, 95% CI 0.04–0.3) tube feeding. Conclusions: The decision to start or withhold tube feeding is associated with the individual physician's perception of the importance of patient wishes versus family wishes and liability concerns. Physician awareness of the influence of these factors on medical decisions may improve the decision-making process.

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