Handout: Alternative Nutrition and Hydration Decision Making
This handout is designed for speech-language pathologists working with patients and interdisciplinary medical team members to make complex medical decisions related to alternative nutrition and hydration. The handout is designed to provide information to SLPs, doctors, nurses, nutritionists, patients, family members, and caregivers. The handout describes the different types of alternative nutrition and hydration methods (PEG vs NG), visualizes the team of people involved in making this decision, and includes two pages of tables packed with evidence-based information about the prognosis, quality of life, risk of aspiration pneumonia, and possibility of curative therapy enabled by alternative nutrition and hydration, organized by major diagnoses. This handout is not meant to be a black/white or yes/no flowchart for this decision. Rather, it provides a broad picture of the evidence base and encourages the decision to be made as a team considering all of the pros and cons of each option.
Full access PDF is $8. Once purchased, you may save to your computer and print as many times as needed for your clinical practice.
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If you purchase 5 color copies, 5 printed color copies will be delivered to your mailbox. Does not include access to PDF file.
Please note that PDFs are not easily opened, saved, or manipulated on phones or tablets. We recommend only downloading on a computer after purchase. Digital download links will be available after payment on the checkout page and in your order confirmation via email. You will have 5 download attempts over 1 month to access the file. Only the purchaser may access and use the file for their own clinical practice.
It is ok to:
- Share a printed copy of this resource with a patient/client, their family members and friends, and non-SLP/OT/PT related staff such as nursing, home healthcare providers, physicians, CNAs, social services, dietitians, activities teams, teachers, caregivers, etc.
- Digitally share the file via online, secure, HIPAA-compliant teletherapy software platforms to any of the people listed in the above point in the context of teletherapy.
It is not ok to:
- Share any digital copy with clients outside of the context of teletherapy.
- Store these files in any publicly accessible online storage system, such as a shared Google drive or other online storage service.
- To share these files with other SLP/OT/PT related colleagues or friends. Please refer, don’t share.
Tech specs: Digital download. 4 pages. 8.5 x 11 inches. PDF format. 15.6 MB.
This handout draws on research from these articles:
Pohar, S., Demarcantonio, M., Whiting, P., Crandley, E., Wadsworth, J., & Karakla, D. (2015). Percutaneous endoscopic gastrostomy tube dependence following chemoradiation in head and neck cancer patients. The Laryngoscope, 125(6), 1366-1371. doi:10.1002/lary.25117
Spataro, R., Ficano, L., Piccoli, F., & Bella, V. L. (2011). Percutaneous endoscopic gastrostomy in amyotrophic lateral sclerosis: Effect on survival. Journal of the Neurological Sciences, 304(1-2), 44-48. doi:10.1016/j.jns.2011.02.016
Rahnemai-Azar, A. A. (2014). Percutaneous endoscopic gastrostomy: Indications, technique, complications and management. World Journal of Gastroenterology, 20(24), 7739. doi:10.3748/wjg.v20.i24.7739
Coutin, Israel B., et al. "Tube feeding and pneumonia: an unhappy couple." Long-Term Care Interface, 2007, p. 21+.
Brady, G. C., Roe, J. W., Brien, M. O., Boaz, A., & Shaw, C. (2017). An investigation of the prevalence of swallowing difficulties and impact on quality of life in patients with advanced lung cancer. Supportive Care in Cancer, 26(2), 515-519. doi:10.1007/s00520-017-3858-6
Loeb, M. B., Becker, M., Eady, A., & Walker-Dilks, C. (2003). Interventions to Prevent Aspiration Pneumonia in Older Adults: A Systematic Review. Journal of the American Geriatrics Society, 51(7), 1018-1022. doi:10.1046/j.1365-2389.2003.51318.x
Nakajoh, K., Nakagawa, T., Sekizawa, K., Matsui, T., Arai, H., & Sasaki, H. (2000). Relation between incidence of pneumonia and protective reflexes in post-stroke patients with oral or tube feeding. Journal of Internal Medicine, 247(1), 39-42. doi:10.1046/j.1365-2796.2000.00565.x
Tomioka, H., Yamashita, S., Mamesaya, N., & Kaneko, M. (2017). Percutaneous endoscopic gastrostomy for aspiration pneumonia: A 10-year single-center experience. Respiratory Investigation, 55(3), 203-211. doi:10.1016/j.resinv.2016.12.005
Groher, M. E., & Groher, T. P. (2012). When Safe Oral Feeding Is Threatened. Topics in Language Disorders, 32(2), 149-167. doi:10.1097/tld.0b013e3182543547
Cowen, M. E., Simpson, S. L., & Vettese, T. E. (1997). Survival Estimates for Patients with Abnormal Swallowing Studies. Journal of General Internal Medicine, 12(2), 88-94. doi:10.1007/s11606-006-5002-z
Gender and Coronary Disease; Two Times What?; Quantity and Quality of Life in Tube Feeding Decisions; and So Much to Do, So Little Time. (1997). Journal of General Internal Medicine, 12(2), 132-136. doi:10.1007/s11606-006-5010-z
Gauderer, M. W. (1991). Percutaneous endoscopic gastrostomy: A 10-year experience with 220 children. Journal of Pediatric Surgery, 26(3), 288-294. doi:10.1016/0022-3468(91)90504-m
Toh Yoon, E. W., Hirao, J., & Minoda, N. (2016). Outcome of Rehabilitation and Swallowing Therapy after Percutaneous Endoscopic Gastrostomy in Dysphagia Patients. Dysphagia, 31(6), 730-736. doi:10.1007/s00455-016-9717-7
Britton, J. E., Lipscomb, G., Mohr, P. D., Rees, W. D., & Young, A. C. (1997). The use of percutaneous endoscopic gastrostomy (PEG) feeding tubes in patients with neurological disease. Journal of Neurology, 244(7), 431-434. doi:10.1007/s004150050117
Romesser, P. B., Romanyshyn, J. C., Schupak, K. D., Setton, J., Riaz, N., Wolden, S. L., … Lee, N. Y. (2012). Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity-modulated radiotherapy with concurrent chemotherapy. Cancer, 118(24), 6072-6078. doi:10.1002/cncr.27633
Ethically justified, clinically comprehensive guidelines for percutaneous endoscopic gastrostomy (PEG) tube placement. (1995). Gastroenterology, 108(4), A31. doi:10.1016/0016-5085(95)22789-x
Jaafar, M. H., Mahadeva, S., Morgan, K., & Tan, M. P. (2016). Systematic review of qualitative and quantitative studies on the attitudes and barriers to percutaneous endoscopic gastrostomy feeding. Clinical Nutrition, 35(6), 1226-1235. doi:10.1016/j.clnu.2016.04.019
Howle, A. A., Nott, M. T., & Baguley, I. J. (2011). Aspiration Pneumonia Following Severe Traumatic Brain Injury: Prevalence and Risk Factors for Long-Term Mortality. Brain Impairment, 12(3), 179-186. doi:10.1375/brim.12.3.179
Mandaville, A., Ray, A., Robertson, H., Foster, C., & Jesser, C. (2014). A Retrospective Review of Swallow Dysfunction in Patients with Severe Traumatic Brain Injury. Dysphagia, 29(3), 310-318. doi:10.1007/s00455-013-9509-2
Hansen, T. S., Larsen, K., & Engberg, A. W. (2008). The Association of Functional Oral Intake and Pneumonia in Patients With Severe Traumatic Brain Injury. Archives of Physical Medicine and Rehabilitation, 89(11), 2114-2120. doi:10.1016/j.apmr.2008.04.013
Kumar, S., Langmore, S., Goddeau, R. P., Alhazzani, A., Selim, M., Caplan, L. R., … Schlaug, G. (2012). Predictors of Percutaneous Endoscopic Gastrostomy Tube Placement in Patients With Severe Dysphagia From an Acute-Subacute Hemispheric Infarction. Journal of Stroke and Cerebrovascular Diseases, 21(2), 114-120. doi:10.1016/j.jstrokecerebrovasdis.2010.05.010
Klor, B. M., & Milianti, F. J. (1999). Rehabilitation of Neurogenic Dysphagia with Percutaneous Endoscopic Gastrostomy. Dysphagia, 14(3), 162-164. doi:10.1007/pl00009599
Wu, K., Chen, Y., Yan, C., Huang, Z., Wang, D., Gui, P., & Bao, J. (2017). Effects of percutaneous endoscopic gastrostomy on survival of patients in a persistent vegetative state after stroke. Journal of Clinical Nursing, 26(19-20), 3232-3238. doi:10.1111/jocn.13672