Feeding Tube Placement in Patients With Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists Purpose To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia. Method A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs. Results The response rate was ... Research Article
Research Article  |   August 01, 2009
Feeding Tube Placement in Patients With Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists
 
Author Affiliations & Notes
  • Helen M. Sharp
    Western Michigan University, Kalamazoo
  • Joseph W. Shega
    Northwestern University, Chicago
  • Contact author: Helen M. Sharp, Western Michigan University, 1903 West Michigan Avenue, Mail Stop #5355, Kalamazoo, MI 49008. E-mail: helen.sharp@wmich.edu.
Article Information
Swallowing, Dysphagia & Feeding Disorders / Special Populations / Older Adults & Aging / Research Articles
Research Article   |   August 01, 2009
Feeding Tube Placement in Patients With Advanced Dementia: The Beliefs and Practice Patterns of Speech-Language Pathologists
American Journal of Speech-Language Pathology, August 2009, Vol. 18, 222-230. doi:10.1044/1058-0360(2008/08-0013)
History: Received March 4, 2008 , Accepted November 25, 2008
 
American Journal of Speech-Language Pathology, August 2009, Vol. 18, 222-230. doi:10.1044/1058-0360(2008/08-0013)
History: Received March 4, 2008; Accepted November 25, 2008
Web of Science® Times Cited: 15

Purpose To describe the beliefs and practices of speech-language pathologists (SLPs) about the use of percutaneous endoscopic gastrostomy (PEG) among patients with advanced dementia and dysphagia.

Method A survey was mailed to a geographically stratified random sample of 1,050 medical SLPs.

Results The response rate was 57%, and 326 surveys met inclusion criteria. Fifty-six percent of SLPs recommended PEG for a patient with advanced dementia and dysphagia. Contrary to the evidence, many respondents believed that PEG improves nutritional status and increases survival. Relatively few SLPs believed that PEG improved patients' functional status or quality of life. Patient factors (e.g., age or prognosis) were more often identified as influences on recommendations for PEG than were extrinsic factors (e.g., cost). Nearly 40% believed that PEG was the standard of care, while 15% believed it should be. Very few SLPs (11%) would want a PEG themselves. Perceived standard of care was significantly related to both geographic region and population density (p < .05), but self-reported practices were not.

Conclusions Discrepancies between SLPs' beliefs, the literature, and self-reported practices were observed. The findings suggest the need to connect the evidence base to clinical practice and to include SLPs in local and national discussions about end-of-life care protocols.

Acknowledgments
This study was funded by American Speech-Language-Hearing Foundation New Investigators Grant 2005-2006 with a grant supplement from Special Interest Division 13, Swallowing and Swallowing Disorders. Joseph Shega was funded by Career Development Award K23AG029815 from the National Palliative Care Research Center and the National Institute on Aging. The sponsors had no role in project development, analysis of the results, or manuscript preparation. Robin Pollens, Andrea Tobochnik, and Lynne Brady Wagner gave valuable suggestions about construction of the survey and discussion of the findings. Devon VanGessel and Rebecca Hague assisted with mailings, data entry, and literature searches. Greg Flamme assisted with statistical analyses. Portions of this study were presented at the American Speech-Language-Hearing Association Pre-Convention Summit on End-of-Life Care in November 2007.
Order a Subscription
Pay Per View
Entire American Journal of Speech-Language Pathology content & archive
24-hour access
This Article
24-hour access