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Open Access Highly Accessed Research article

A decision aid regarding long-term tube feeding targeting substitute decision makers for cognitively impaired older persons in Japan: A small-scale before-and-after study

Yumiko Kuraoka* and Kazuhiro Nakayama

Author Affiliations

Department of Nursing, St. Luke’s College of Nursing, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan

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BMC Geriatrics 2014, 14:16  doi:10.1186/1471-2318-14-16

Published: 5 February 2014



In Japan, there is no decision-making guide regarding long-term tube feeding that specifically targets individuals making decisions on behalf of cognitively impaired older persons (substitute decision makers). The objective of this study was to describe the development and evaluation of such a decision aid.


In this before-and-after study, participants comprised substitute decision makers for 13 cognitively impaired inpatients aged 65 years and older who were being considered for placement of a percutaneous endoscopic gastrostomy tube in acute care hospitals and mixed-care hospitals in Japan. Questionnaires were used to compare substitute decision makers’ knowledge, decisional conflict, and predisposition regarding feeding tube placement before and after exposure to a decision aid. The acceptability of the decision aid was also assessed. Paired t-tests were used to compare participants’ knowledge and decisional conflict scores before and after using the decision aid.


Substitute decision makers showed significantly increased knowledge (P < .001) and decreased decisional conflict (P < .01) regarding long-term tube feeding after using the decision aid. All substitute decision makers found the decision aid helpful and acceptable.


The decision aid facilitated the decision-making process of substitute decision makers by decreasing decisional conflict and increasing knowledge.

Decision-making; Feeding tube; Gastrostomy; Older people