“I Wouldn't Ever Want It”: A Qualitative Evaluation of Patient and Caregiver Perceptions Toward Enteral Tube Feeding in Hip Fracture Inpatients

Abstract

A number of factors impacted the likelihood of tube acceptance. This highlights the importance of food as a medicine, treatment intent, and shared decision making when considering ETF in acute hip fracture inpatients.

Why Don’t We Tube Feed Hip Fracture Patients? Findings from the Implementation of an Enteral Tube Feeding Decision Support Tool

“…The answer to this question is complex and is unable to be addressed by applying algorithmic processes or population-based recommendations for multimorbid, older patient populations [ 9 , 10 ]. This is particularly relevant in hip fracture, where evidence for overall benefits versus the risk for multiple and sometimes conflicting interventions remains unclear [ 8 , 18 ].…”

“…The balance of risk in this situation can be difficult to quantify and may need to be considered along with the patient’s nutrition status, level of swallowing dysfunction and the need to take oral medications. These reasons alone must be viewed through the lens of patient treatment goals, perceived quality of life, and what is in the individual patient’s best interest [ 9 , 16 , 22 ]. For this reason, we would advocate that whilst an algorithm may be entirely inappropriate, a subjective decision support tool may facilitate clinical decision making.…”

“…The complex and invasive nature of ETF and the lack of supporting efficacy evidence makes this a complex decision-making process. Adding to this complexity, when the treating team does recommend ETF as a potential treatment option, are a series of factors that influence a patient’s decision to accept ETF or not [ 9 , 22 ]. King et al, (2017) explored ETF preferences with patients and carers, finding that most patients do not perceive EFT to be a treatment option they would likely accept.…”

“…In the absence of high-level evidence or recommendations regarding if and when to commence ETF in hip fracture patients, the decision to use enteral nutrition options should be made between the patient (and their carers) and their treating team in a shared decision process. A recent study highlighted the complex interplay of factors relating to patient acceptance of ETF related to knowledge and understanding, patient refusal and necessity of the tube as key patient and carer barriers to implementing enteral tube feeding in hip fracture patients [ 9 ]. In the absence of a supporting evidence base, determining what care should be provided may be considered using a two-step approach.…”

Nutritional Care of the Older Patient with Fragility Fracture: Opportunities for Systematised, Interdisciplinary Approaches Across Acute Care, Rehabilitation and Secondary Prevention Settings

“…In this situation, meeting a patient's nutritional requirements is obviously irrelevant, and nutrition treatment goals and strategies should focus on their comfort [79]. In contrast, the appropriateness of reinserting an enteral feeding tube, after its removal by a malnourished, acutely delirious hip fracture patient, is far more complex and would require attention to clinical judgement and shared decision-making [80,81].…”