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Improving decision‐making for feeding options in advanced dementia: A randomized, controlled trial


Hanson, Laura C., Carey, Timothy S., Caprio, Anthony J., Lee, Tae Joon, Ersek, Mary, Garrett, Joanne, Jackman, Anne, Gilliam, Robin, Wessell, Kathryn, Mitchell, Susan L.


Journal of the American Geriatrics Society, Volume: 59, No.: 11, Pages.: 2009-2016

Year of Publication



Objectives: To test whether a decision aid improves quality of decision‐making about feeding options in advanced dementia. Design: Cluster randomized controlled trial. Setting: Twenty‐four nursing homes in North Carolina. Participants: Residents with advanced dementia and feeding problems and their surrogates. Intervention: Intervention surrogates received an audio or print decision aid on feeding options in advanced dementia. Controls received usual care. Measurements: Primary outcome was the Decisional Conflict Scale (range: 1–5) measured at 3 months; other main outcomes were surrogate knowledge, frequency of communication with providers, and feeding treatment use. Results: Two hundred fifty‐six residents and surrogate decision‐makers were recruited. Residents’ average age was 85; 67% were Caucasian, and 79% were women. Surrogates’ average age was 59; 67% were Caucasian, and 70% were residents’ children. The intervention improved knowledge scores (16.8 vs 15.1, P < .001). After 3 months, intervention surrogates had lower Decisional Conflict Scale scores than controls (1.65 vs 1.90, P < .001) and more often discussed feeding options with a healthcare provider (46% vs 33%, P = .04). Residents in the intervention group were more likely to receive a dysphagia diet (89% vs 76%, P = .04) and showed a trend toward greater staff eating assistance (20% vs 10%, P = .08). Tube feeding was rare in both groups even after 9 months (1 intervention vs 3 control, P = .34). Conclusion: A decision aid about feeding options in advanced dementia reduced decisional conflict for surrogates and increased their knowledge and communication about feeding options with providers. (PsycINFO Database Record (c) 2012 APA, all rights reserved). (journal abstract)

Bibtex Citation

@article{Hanson_2011, doi = {10.1111/j.1532-5415.2011.03629.x}, url = {}, year = 2011, month = {sep}, publisher = {Wiley-Blackwell}, volume = {59}, number = {11}, pages = {2009--2016}, author = {Laura C. Hanson and Timothy S. Carey and Anthony J. Caprio and Tae Joon Lee and Mary Ersek and Joanne Garrett and Anne Jackman and Robin Gilliam and Kathryn Wessell and Susan L. Mitchell}, title = {Improving Decision-Making for Feeding Options in Advanced Dementia: A Randomized, Controlled Trial}, journal = {J. Am. Geriatr. Soc.} }


advanced dementia, decision aid, decision making, dementia, diet, eating behavior, feeding, feeding options, health care delivery, improved, knowledge, nursing homes, options

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cluster RCT

Type of Outcomes

Other, Other carer outcomes (e.g. financial burden and more), Satisfaction with care/services


Nursing Homes

Type of Interventions

Intervention for Carers, Non-pharmacological Treatment

Non-Pharmaceutical Interventions


Carer Focussed Interventions

Training programmes / workshops including behavioural training