Caregiver Decisional Conflict Before and After Consultation About Gastrostomy Tube Placement.

OBJECTIVES: Families describe decision-making about gastrostomy tube (g-tube) placement as challenging. We measured caregiver decisional conflict before and after initial g-tube consultation to evaluate the potential benefit of a decision aid and feasibility in testing it. METHODS: Families presenting for initial consultation about g-tube placement completed the decisional conflict scale (DCS) at 1 or 2 of 3 time points: before consultation, after consultation, and after viewing a video. The decision support consultation was a 2-hour structured meeting with a pediatric hospitalist, nurse practitioner, and dietitian that was focused on clarifying the indication, feasibility, safety, and family values around tube placement. The video described decision-making and lived experiences of families with tube feeding. RESULTS: We measured the decisional conflict of 61 caregivers. Preconsultation decisional conflict scores were high (mean = 38.7), but there was substantial variation between families (SD = 19.4). Baseline scores did not vary between clinically relevant subgroups. Postconsultation DCS scores were lower (17.9 and SD = 13.5 for consult alone; 12.7 and SD = 13.2 for consult with video). Three caregivers (7.7%) of families had residual decisional conflict scores >37.5, the threshold conventionally associated with decision delay. CONCLUSIONS: Measuring decisional conflict among caregivers deciding about pediatric g-tube is feasible during the clinical encounter. Residual decisional conflict after our institution's current decision support consultation model (with or without an additional video) was low, so development of an additional structured decision aid is not warranted. Further study of preconsult DCS variability across different clinical subgroups may help identify families benefiting from additional decisional support.

Factors associated with body mass index among slum dwelling women in India: an analysis of the 2005-2006 Indian National Family Health Survey.

BACKGROUND: Urbanization is increasing around the world, and in India, this trend has translated into an increase in the size of slum dwellings whose environments are suspected of being associated with poor health outcomes, particularly those relating to women's nutritional status. With this study, we sought to determine the factors associated with Indian women's body mass index (BMI) in slum environments, with special attention paid to women with tribal status. METHODS: A multiple linear regression analysis was performed on data from the Indian National Family Health Survey (2005-2006), modeling demographic and behavioral factors suspected of being associated with BMI, with additional focus on the measures of social class, specifically caste and tribal status. RESULTS: Increasing BMI is significantly and positively associated with frequency of watching television, having diabetes, age, wealth index, and residency status in the areas of New Delhi, Andhra Pradesh, or Tamil Nadu. CONCLUSION: Although belonging to a scheduled tribe was not associated with changes in BMI, unadjusted rates suggest that tribal status may be worthy of deeper investigation. Among slum dwellers, there is a double burden of undernutrition and overnutrition. Therefore, a diverse set of interventions may be required to improve the health outcomes of these women.