The decision to accept a feeding tube can often be extremely difficult, with patients expressing fear that they may "never eat again," or family members worrying that placement of a feeding tube represents a terminal stage in the disease progression.
Any decision to place a feeding tube should always, first and foremost, be done with regard to what the individual, the patient, wants. If they are clear thinking and able to express their wishes, those wishes should be respected. If the patient is unconscious or unable to communicate, than a health care surrogate, the person speaking on their behalf, will have to make that decision, based on prior preferences expressed by the individual.
There is no correct answer for every situation. But below are some questions to consider:
1. Do you (if you are the patient) or does the patient have a swallowing problem related to a disease or illness from which full or some recovery is expected? Examples of this might be: someone undergoing head and neck cancer treatment, someone who has suffered a recent stroke or head injury. Someone in the early stages of ALS with mild to moderate swallowing difficulty.
If your answer is "yes," a feeding tube might represent the best of both worlds. Once in place, the feeding tube can provide a way to maintain or gain weight safely, while still eating or drinking some things by mouth. In this instance, a speech pathologist or swallowing therapist can guide the patient regarding safe food choices. If recovery of safe swallowing function eventually occurs, the feeding tube can be easily removed and you will go on to eat normally like before your illness.
2. Is your disease a progressive disease,which now has caused overall weakness and weight loss or aspiration pneumonia?
If your answer is "yes," a feeding tube may still be a reasonable choice.
Once in place, like in the example above, you may actually begin to feel better once you are receiving improved nutrition via the feeding tube. Some food or liquid may still be safely taken normally, and in this instance, it may be smaller amounts for "pleasure" and for social functions, with most of your nutrition coming form the tube.
3. Are you or a family member gravely ill from an illness from which survival is unlikely? Has the patient stopped eating as a symptom of the progression of dementia?
If you have answered "yes," a feeding tube may not be the best choice. Research in this area suggests that placement of a feeding tube will not likely add to quality of life, and may actually interfere with the natural progression of the disease process which is typically not painful or uncomfortable
If the individual is still awake and responding, a swallowing therapist can be helpful in identifying those foods and liquid consistencies which can be taken most safely. This may include foods that are blenderized or liquids that are thickened so they can be held more safely in the mouth and be less likely to get misdirected into the windpipe.
A decision to have a feeding tube placed can lead to family squabbles, guilt, or fear. The decision should never be forced upon anyone, and you should always ask for enough information to make an informed choice. A speech-language pathologist/swallowing therapist can help you understand all of the options and guide and support you into making the best decision for your particular situation.
About this Author
Mary Spremulli,MA,CCC-SLP, is a licensed speech-language pathologist, licensed nurse, and national seminar leader, with publications on the topic of Patient Education and Ethics. Voice Aerobics,LLC, is a private practice offering speech-language pathology treatment and home programs for improving voice, speech, and swallowing for individuals with Parkinson's and other neurological disorders. Voice Aerobics DVD(TM), Voice Aerobics Grand Slam (TM), and Voice Aerobics(TM) Songbirds are products offered for individuals to use at home, on their own.
To learn more visit: http://www.voiceaerobicsdvd.com/ or http://voiceaerobicsdvd.blogspot.com/
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