Physicians' Knowledge of Medical Nutrition for Patients with Advanced Dementia (QI624)

Abstract

•Describe the gaps in education of the benefits and harms of medical nutrition for patients with dementia.•Identify areas for further research in education around medical nutrition for patients with progressive dementia. Dementias are progressive and incurable, leading to a profound loss of cognitive function with a final phase characterized by reduced oral intake. The availability of medical nutrition has made treatment decisions more complex for surrogates, and despite studies and National Society recommendations to the contrary, many physicians continue to place feeding tubes in patients with dementia. Describe the gaps in education around medical nutrition for patients with progressive dementia. After IRB approval, we conducted a crosssectional, anonymous survey of residents' and attending physicians' knowledge of medical nutrition for patients with advanced dementia. Fifty physicians of 160 surveyed responded for a response rate of approximately 32%. Almost 23% (n=11) of respondents believe that medical nutrition is the standard of care, and less than 10% feel that there are no other alternatives. Only 39% (n=19) of respondents correctly answered that medical nutrition can increase the risk of aspiration pneumonia, while 25% (n=12) correctly answered that there is an increased 30-day mortality. Close to 25% (n=11) of respondents believed that they were medically or ethically obligated to offer medical nutrition to patients with advanced dementia. There were no statistically significant distributional differences in total knowledge scores for age group, gender, or role. There was a marginal positive association with years since medical school (Spearman p=0.05); if grouped according to < 3 years vs. 3+ years, there was a statistically significant difference in knowledge scores (p=0.03). Residents and hospitalists at our institution have limited knowledge of the evidence and recommendations for best practices for medical nutrition in patients with advanced dementia. The results of our study suggest that both resident and attending physicians maintain misconceptions about their medical and ethical obligations to offer medical nutrition. Further investigation is warranted to explore if improving education around the harms and benefits of medical nutrition could impact practice patterns and change physicians' concerns around ethical obligation.