[Dysphagia] dysphagia/dementia

[atsslp at yahoo.com (Alyce Schoenagel)]

Candace,
         I often find myself in your situation.  The MD's are initially pressured by the family to "do everything"...then we are consulted.  I go right to to family, provide lots of verbal and written education re: palliative care vs alt feeding. I am sure to include concepts such as quality vs quantity of life, asking the family to think of what the PATIENT would want, 
and to try to do what is best for the PATIENT, not what makes them feel best/less guilty.
I find if the family is receptive to listening, is capable of understanding the information, and is asked to view their decision through the eyes of their loved one, even if the MD is yelling PEG tube, the family will often opt out. My second line of defense is giving the GI Doc a "heads up" that Mrs---may be referred for PEG consult, and that it is not appropriate given current condition (our GI guy shares my philosophy).  I also speak with SW, from the $ point, that this Pt may not meet medicare guidelines for PEG ( has physiology to ingest PO but is slow,. laborious, refuses etc).  After I've done my best, I 
sign off the case, knowing some of the families will still make that emotional decision to place the PEG...
Alyce Schoenagel
Harford Memorial Hosp

			
---------------------------------
Do you Yahoo!?
 Check out the new Yahoo! Front Page.  www.yahoo.com/a