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October 15, 2003

Communicating Life Expectancy to Patients With Terminal Illness

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(15):1995-1996. doi:10.1001/jama.290.15.1995-a

In Reply: In response to Dr Buff, we found that the use of tube feeding varied among facilities even within the same state. Therefore, while state factors may explain some of the nationwide variation in tube-feeding practice, features of individual facilities must also be important determinants. It would be reasonable to assume that varying state legislation regarding the use of parenteral nutrition and hydration would influence tube-feeding practice. In our study,1 New York was the 17th highest state in the overall proportion of tube-fed nursing home residents with advanced cognitive impairment in the country. Moreover, we previously reported that state legislation regarding the use of parenteral nutrition and hydration was not found to be associated with tube-feeding use at the state level.2 It is difficult to quantify such legislation in a statistical model. We agree that the influence of state legislation on tube-feeding practice in advanced dementia remains unclear and requires further study.

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