Initiating artificial nutrition support: a clinical judgement analysis

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Background: Variations in the practice of artificial nutrition are partly a result
of the judgements of clinicians. Little is known about these judgements, the
decision processes used or the quality of the decisions that arise. The methodology of clinical judgement analysis describes and explains judgemental differences between clinicians and offers a window into why clinician choices
sometimes fail to correspond with current best practice guidelines. Methods: A clinical judgement analysis with 27 clinicians using two judgement tasks was carried out. Clinicians expressed their ‘likelihood of feeding’ and ‘whether or not they would initiate artificial nutrition support’ in response to 54 patient scenarios. Measures of agreement between clinicians, the degree of linear reasoning employed, their judgemental consistency and concordance with National Institute for Health and Clinical Excellence (NICE) guidelines were assessed. Results: Clinicians’ judgements varied substantially both in the amount of information employed and the weighting given to information. Clinicians had only moderate agreement with NICE recommendations and overestimated the need for artificial nutrition support. Suboptimal judgements were consistently applied by clinicians. When clinicians reasoned in more linear ways, their judgements and decisions improved. Conclusions: Overestimating the need for artificial nutritional support may inflate health service costs and increase risks for patients unnecessarily. A better understanding by clinicians of the information needed (as well as how to use it) for artificial nutrition support initiation may help improve clinical decisionmaking.
Original languageEnglish
Pages (from-to)427-434
Number of pages8
JournalJournal of human nutrition and dietetics
Issue number5
Publication statusPublished - Oct 2012

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