Departmental Bulletin Paper 高齢者の胃瘻栄養法などの経管栄養に関する選択と意思表示について
A study about the decision making for tube feeding including percutaneous endoscopic gastrostomy (PEG) and a living will

杉山, 英子  ,  竹腰, 節子  ,  横山, 伸

The recent development of tube feeding enables a person who is unable to take anything by mouth because of aging and/or diseases to be alive longer. To present, a percutaneous endoscopic gastrostomy (PEG) has been frequently used because of its convenience and safety. However, the easy use of PEG has been criticized and reconsidered during the last decade. The problem associated with the decision making of the patient and his/her family is still remained. Sometimes the family faces to the decision making process with a conflict on behalf of their family member who is supposed to be fed by tube. Therefore, it would be convenient for us to utilize a “living will display card” similar to an “organ supply will display card” in order to show our living will. We examined the knowledge and the attitude toward tube feeding at the end-of-life nutrition among the people lived in the northern part of Nagano prefecture, and to obtain their evaluation about a “living will display card”, which we proposed. A questionnaire survey was preformed and the recovery rate was 92%.  As results, the survey revealed a poor knowledge of the subjects about the tube feeding. Less than 40% of the subjects did not know the fact that the living will is not necessarily required for starting the tube feeding. The knowledge about the tube feeding based on their personal experiences seemed to contribute the refusal of persistent use of tube feeding. About a half of the subjects affirmatively answered to use “living will display card”. More than 70% of the subjects showed the respect toward their family member’s will in case the member would refuse the tube feeding in the end-of-life using the card. Not only the “living will display card” would let the family to respect their member’s will, it would also provide them a chance to discuss about nutrition at the end-of-life for their family member.

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