Background:
The initiation or withdrawal of artificial nutrition, via nasogastric and gastrostomy tubes, is a common and difficult issue in medical practice. Resident physicians and hospitalists frequently involve families in making these decisions, as the patients are generally hospitalized and often too ill to decide for themselves. However, little is known about the attitudes of residents and hospitalists regarding artificial nutrition, particularly attitudes for patients who have severe dementia or are in a persistent vegetative state. In addition, little is known about resident and hospitalist familiarity with the risks and benefits of artificial nutrition and hydration.
Methods:
A survey regarding artificial nutrition was sent by e‐mail to 100 internal medicine residents and hospitalists at 2 community‐based teaching hospitals. Participants were asked several questions about their attitudes toward artificial nutrition and were also asked to decide on initiation or withdrawal of artificial nutrition in 3 clinical scenarios. Responses were confidential and anonymous.
Results:
Fifty‐seven percent of the surveys were returned, of which half were from residents and half from hospitalists. Eighty‐eight percent believed that artificial nutrition was medical therapy as opposed to basic humane therapy. Respondents believed that providing artificial nutrition to patients who have end‐stage dementia or are in a persistent vegetative state does not make the patients more comfortable (81%) and does not decrease the risk of aspiration pneumonia (86%). Overall, 40% of the respondents believed that in their experience, artificial nutrition was used inappropriately in 40% of the cases in which they had been involved.
Three scenarios were presented. Ninety‐one percent of physicians disagreed with the placement of a feeding tube in a 79‐year‐old female patient with end‐stage dementia, in no obvious distress, and refusing to eat. Most respondents were neutral about the use of artificial nutrition in an 85‐year‐old man with multiple medical problems who presented with pneumonia. Seventy‐two percent of physicians agreed with the removal of a gastrostomy tube from a 37‐year‐old woman in a persistent vegetative state.
Conclusions:
The use of artificial nutrition is common in patient care in 2007. Although artificial nutrition is accepted as a form of medical treatment both legally and ethically, the attitudes of counseling physicians are important factors in family decision making. Our data suggest that although physicians demonstrated knowledge about the risks and benefits of artificial nutrition, there was still no consensus about how to treat some patients at the end of life, particularly patients in a persistent vegetative state. It is important that residents and hospitalists are educated about the risks and benefits of artificial nutrition.
Author Disclosure:
J. Markee, None.