’To feed or not to feed’ - can decisions be improved for individual patients following a stroke?
This research study ascertains whether the sharing of knowledge between doctors, nurses and relatives of stroke patients can assist the ‘feed or not to feed’ decision making process. The research questions are:- a) What factors do doctors and nurses believe influence the ‘feed or not to feed’ decision? b) What factors emerge when asking the views of relatives of stroke patients regarding their involvement in the decision and personal knowledge of the patient? c) What information/involvement would relatives of stroke patients (who are currently being enterally fed in long term care settings) have welcomed when the decision to commence feeding was made? d) Could analysis of these factors be utilised to influence practice? Analysis of qualitative interviews with these groups indicate which factors emerge and influence decision making. Greater depth of knowledge and understanding of the issues for each group enables information to be utilised to make the best decision for each individual patient. The study focusses on stroke patients aged 65 years+ who cannot swallow food safely and are unable to participate in decision making. The study population is comprised of doctors, nurses and relatives of patients within the first week of stroke. The relatives of patients who have survived more than six weeks are included in the study. Advances in stroke treatments within the acute phase are being made. As more people survive their stroke, ethical dilemmas have increased. A major ethical dilemma encountered is the ‘feed or not to feed’ issue. Commencing or withholding tube feeding in an individual unable to swallow is a highly emotionally charged decision. Currently there is no evidence or consensus of opinion to indicate when or if feeding should be instigated. Research is being undertaken in a large international trial and will provide evidence with regard to timing and type of nutritional support but the issue of decision making for the individual has not been studied. The study proposes that the combination of specialist clinical and personal individual knowledge of the patient will assist decision making. Preliminary findings will be presented.