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. chi(2) 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.
Subject(s)
Attitude of Health Personnel , Decision Making , Enteral Nutrition , Practice Patterns, Physicians' , Adult , Advance Directive Adherence , Chi-Square Distribution , Cross-Sectional Studies , Defensive Medicine , Female , Humans , Logistic Models , Male , Medical Futility , Middle Aged , Physician-Patient Relations , Physicians, Family/psychology , Professional-Family RelationsABSTRACT
INTRODUCTION: Despite a growing need for physicians providing care to nursing home patients, the characteristics of physicians providing such care are not well described. METHODS: A survey was sent to adult primary care physicians in Hawai'i; respondents' demographic data were obtained. Associations between physician characteristics, level of nursing home experience, and island of practice were analyzed using chi square and multivariate logistic regression models. RESULTS: Of 806 physicians, 388 (48%) returned surveys. Controlling for years of experience and other demographic factors, having nursing home experience was associated with physician age (40 years and over compared with under 40 years; OR 3.5, 95% Confidence Interval (CI) 1.4-8.5), Family Medicine specialty (compared with Internal Medicine, General Practice or Other; OR 4.0, 95% CI 1.4-11.4), private practice type (compared with employed, other, and trainee physicians; OR 2.3, 95% CI 1. 1-4.6), and practice location (neighbor islands compared with Oahu, OR 4.5, 95% CI 1.1-17.8). Physicians practicing on the neighbor islands were more likely to be aged 40 years and older (OR 3.9, 95% CI 1.4-10.3), and white (ethnicity compared with all other ethnicities, OR 4.1, 95% CI 2.1-7.7). CONCLUSION: The association of higher physician age with both nursing home experience and neighbor island practice has important implications for the training of physicians to provide nursing home care in Hawai'i.
