Tube Feeding in Patients with Advanced Dementia: Knowledge and Practice of Speech-Language Pathologists

Context. Speech-language pathologists (SLP) are often called on to evaluate eating difficulties in patients with dementia. Objectives. To assess factors associated with SLPs' knowledge and recommendations about feeding tubes in patients with advanced dementia. Methods. A mail survey was administered to a probability sample of 1500 SLPs from the American Speech-Language-Hearing Association mailing list; 731 usable surveys were received (response rate 53.7%). Self-perceived preparedness, knowledge, and care recommendations were measured. Knowledge items were scored as "evidence based" or not according to the best evidence in the literature. Results. Only 42.1% of SLP respondents felt moderately/well prepared to manage dysphagia. Only 22.0% of respondents recognized that tube feeding is unlikely to reduce risk of aspiration pneumonia whereas a slight majority understood that tube feeding would not likely prevent an uncomfortable death (50.2%), improve functional status (54.5%), or enhance quality of life (QOL) (63.2%). A majority (70.0%) was willing to consider recommending oral feeding despite high risk of aspiration. Logistic regression analyses indicated that those willing to consider this recommendation gave the most evidence-based responses to knowledge questions about tube feeding outcomes: aspiration pneumonia (odds ratio [OR] = 1.75, 95% confidence interval [CI] = 1.07-2.87), functional status (OR = 1.43, 95% CI = 1.0-2.06), QOL (OR = 2.19, 95% CI = 1.52-3.17), and prevent uncomfortable death (OR = 1.97, 95% CI = 1.37-2.88). Logistic regression analyses also indicated that those with more experience evaluating patients with dementia gave the most evidence-based response to two knowledge questions: aspiration pneumonia (OR = 2.64, 95% CI = 1.48-4.72) and prevent uncomfortable death (OR = 2.03, 95% CI = 1.35-3.05) whereas those with higher self-perceived preparedness in managing dysphagia in dementia had less knowledge in two areas: aspiration pneumonia (OR = 0.57, 95% CI = 0.38-0.84) and QOL (OR = 0.72, 95% CI = 0.51-1.01). Conclusion. Misperceptions among SLPs about tube feeding in advanced dementia are common, especially in relation to risk of aspiration. Knowledge about tube feeding outcomes was positively associated with experience and inversely associated with self-perceived higher preparedness in evaluating patients with dementia. J Pain Symptom Manage 2011;42:366-378. (C) 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.