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Recognizing Patient Discomfort When Forgoing Artificial Nutrition and Hydration in Severe Dementia—Reply
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In reply
We agree with Burke and Travaline regarding their concerns about the properties of the DS-DAT. For this reason, our article included an extensive consideration of the methodological issues, including all possible problems with the DS-DAT, among which is the possibility that the level of consciousness might affect the score on the DS-DAT.1 Because of these considerations, we explicitly mentioned that conclusions should be drawn carefully.
Nonetheless, because the DS-DAT has shown acceptable psychometric properties in several studies, including our study, we consider it a suitable instrument. We do not consider the substantial individual differences of the scores on the DS-DAT as a study limitation but as a study result, showing that it always remains important to look at signs for discomfort in each individual patient.
We also agree with Burke and Travaline that patients should be offered oral fluids and soft foods as tolerated. Our data show that . . . [Full Text of this Article]
AUTHOR INFORMATION
H. Roeline W. Pasman, PhD;
Bregje D. Onwuteaka-Philipsen, PhD
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Recognizing Patient Discomfort When Forgoing Artificial Nutrition and Hydration in Severe Dementia
Greg F. Burke and John M. Travaline
Arch Intern Med. 2006;166(4):472.
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Discomfort in Nursing Home Patients With Severe Dementia in Whom Artificial Nutrition and Hydration Is Forgone
H. Roeline W. Pasman, Bregje D. Onwuteaka-Philipsen, Didi M. W. Kriegsman, Marcel E. Ooms, Miel W. Ribbe, and Gerrit van der Wal
Arch Intern Med. 2005;165(15):1729-1735.
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