• E Amanda Snyder, Anthony J Caprio, Kathryn Wessell, Feng Chang Lin, and Laura C Hanson.
• Division of Geriatric Medicine and Center for Aging and Health, School of Medicine, University of North Carolina, Chapel Hill, NC 27759, USA.
• J Am Med Dir Assoc. 2013 Feb 1;14(2):114-8.

ObjectivesIn advanced dementia, feeding problems are nearly universal, and families face difficult decisions about feeding options. Initial interviews for a randomized trial were used to describe surrogates' perceptions of feeding options, and to determine whether a decision aid on feeding options in advanced dementia would improve knowledge, reduce expectation of benefit from tube feeding, and reduce conflict over treatment choices for persons with advanced dementia.DesignSemistructured interview with prestudy and poststudy design for surrogates in the intervention group.SettingTwenty-four skilled nursing facilities across North Carolina participating in a cluster randomized trial.ParticipantsTwo hundred and fifty-five surrogate decision makers for nursing home residents with advanced dementia and feeding problems, in control (n = 129) and intervention (n = 126) groups.InterventionFor intervention surrogates only, an audiovisual-print decision aid provided information on dementia, feeding problems in dementia, advantages and disadvantages of feeding tubes or assisted oral feeding options, and the role of surrogates in making these decisions.MeasurementsThe interview included open-ended items asking surrogates to report advantages and disadvantages of tube feeding and assisted oral feeding. Knowledge of feeding options was measured with 19 true/false items and items measuring expectation of benefit from tube feeding. Surrogates reported which of these two feeding options they preferred for the person with dementia, and how confident they were in this choice; their level of conflict about the choice was measured using the decisional conflict scale.ResultsBefore the decision aid, surrogates described advantages and disadvantages of assisted oral feeding and tube feeding in practical, ethical, and medical terms. After review of the decision aid, intervention surrogates had improved knowledge scores (15.5 vs 16.8; P < .001), decreased expectation of benefits from tube feeding (2.73 vs 2.32; P = .001), and reduced decisional conflict (2.24 vs 1.91; P < .001). Surrogates preferred assisted oral feeding initially and reported more certainty about this choice after the decision aid.ConclusionsA structured decision aid can be used to improve decision making about feeding options in dementia care.Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

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