Feeding Tubes: the Decision Process

undefinedAt Crossroads Hospice, the comfort level of the patient’s family is as important as the care we provide for the patient. Our staff takes the time to sit down with the family, and educate them on a variety of topics and issues that may arise with hospice care.

One topic that many families seem to know little about is feeding tubes. Opting for a feeding tube for a loved one isn’t a simple black-or-white, yes-or-no, situation. Once this option has been introduced, it’s critical for the family to have the information and counseling they need to make the right decision for the patient.

What is a feeding tube?

A feeding tube is an alternative to food and water for people who have difficulty swallowing or drinking. It’s a small plastic tube that directly delivers nutrients to the stomach through the nose, abdomen or small intestine.

There are three types of feeding tubes:

A Nasogastric tube is a small, very thin flexible tube placed via a nostril down the back of the throat into the stomach. These tubes tend to be used temporarily, usually for a few weeks, to help the patient “get over” a self-limited condition.

A PEG is a tube placed through the abdominal wall directly into the stomach with the use of a special Endoscope. It is used for long-term tube feedings.

A “J” (Jejunostomy) tube is a surgically placed feeding tube into the upper small intestine. It is for long-term use, usually in patients with poor stomach emptying issues.

What are the first steps for deciding whether or not to choose a feeding tube?

 Educate yourself: Ask the doctor to explain all your options and the possible complications.

 Step back and ask yourself: If your mother, father, or loved one could speak and see themselves clearly as they presently are, would they want the tube placed?

 Do some additional research for yourself and your loved one: visit the Family Caregiver Alliancewebsite.

What happens if you decline a feeding tube?

If the patient and/or family declined placement of a feeding tube, the patient is given food orally to tolerance. Although they may not be capable of consuming enough calories to maintain their weight, they are not hungry. Comfort measures are then provided to ensure the patient is not experiencing pain or shortness of breath.

At this time, information and counseling can be critical for helping the patient, and caregivers, feel at peace with their decisions.

The role of hospice.

In most situations, the inability to eat marks the beginning of the “end-of-life” journey. If the patient has a terminal diagnosis, they may be eligible for hospice care. Hospice involves a team approach to decision-making and patient care. The expert team consists of clergy, nurses, social workers and physicians who can help guide you through the process.  Personal and individual counseling is available for the family and the patient to help explain and clarify late-life issues.

 

undefinedDr. Mortimer James Strong, DO
Medical Director, Crossroads Hospice
Philadelphia, PA

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