Healthcare professionals' attitudes towards PEG tube feeding in advanced dementia: time to engage with a wide clinical audience?

Adu-Tei, Sebastian; Penny, Hugo A; El-Fekhi, Mansour; Ruse, Charlotte; Sanders, David S.

doi:10.23736/s1121-421x.19.02588-1

Cited by 2 publications

(5 citation statements)

References 5 publications

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“…22 Formal training in healthcare professionals has been found to be as low as 15%. 20 Around a quarter of patients referred for PEG do not undergo the procedure and mortality in this group was found to be approximately 75% at 1 year. 23 Junior medical staff and nurses were more likely to recommend PEG feeding in elderly advanced dementia patients than dietitians, gastroenterologists and geriatricians.…”

Section: Healthcare Professionalsmentioning

confidence: 99%

“…A common belief, even among healthcare professionals, is that a PEG will automatically be of benefit. 16,20 It becomes difficult to adjust this belief, especially when a PEG has already been suggested by a healthcare professional. Decisions will have a time limit and it is unlikely a decision can be made without an emotional involvement.…”

Section: Familymentioning

confidence: 99%

“…Views among healthcare professionals when it comes to a PEG vary greatly. 20 Decisions are influenced by culture, religion, education and likely pressure from a patient's family members. 22 Formal training in healthcare professionals has been found to be as low as 15%.…”

Section: Healthcare Professionalsmentioning

confidence: 99%

“…23 Junior medical staff and nurses were more likely to recommend PEG feeding in elderly advanced dementia patients than dietitians, gastroenterologists and geriatricians. 20…”

Section: Healthcare Professionalsmentioning

confidence: 99%

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Cui bono? PEG feeding

Parr

Sanders

2021

Clinical Medicine

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Percutaneous endoscopic gastrostomy (PEG) provides longterm nutritional support to those unable to tolerate intake orally. The benefits of a PEG depend on the indication and the individual, and are considered when it has the potential to improve mortality, nutritional status or quality of life. Often, family members and healthcare professionals have to act on behalf of the patient. It is difficult for their personal values and emotions to not be a factor when deciding if to proceed with a PEG. This may result in unnecessary PEG placement. For certain indications (dementia for example), there is limited evidence of any benefits a PEG may give and may actually cause harm. Guidance to improve patient selection and increase education for healthcare professionals is essential in achieving the best outcome for the patient.

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Section: Healthcare Professionalsmentioning

confidence: 99%

Section: Familymentioning

confidence: 99%

Section: Healthcare Professionalsmentioning

confidence: 99%

“…23 Junior medical staff and nurses were more likely to recommend PEG feeding in elderly advanced dementia patients than dietitians, gastroenterologists and geriatricians. 20…”

Section: Healthcare Professionalsmentioning

confidence: 99%

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Cui bono? PEG feeding

Parr

Sanders

2021

Clinical Medicine

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“…The decision to proceed with a gastrostomy varies greatly among health professionals. It is influenced not only by clinical judgement but also by individual beliefs of the clinician, other allied healthcare professionals, the patient and family/carers 3 4. Large, good-quality studies are scarce and there is not always sufficient evidence to suggest it will be of benefit, particularly in those with dementia or multiple comorbidities 5.…”

Section: Introductionmentioning

confidence: 99%

What is the current provision of service for gastrostomy insertion in England?

Parr

Williams

White

et al. 2022

Frontline Gastroenterol

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BackgroundSignificant morbidity and mortality can be associated with gastrostomy insertion, likely influenced by patient selection, indication and aftercare. We aimed to establish what current variation in practice exists and how this has improved by comparison to our previously published British Society of Gastroenterology survey of 2010.MethodsWe approached all National Health Service (NHS) hospitals in England (n=198). Email and web-based questionnaires were circulated. These data were correlated with the National Endoscopy Database (NED).ResultsThe response rate was 69% (n=136/198). Estimated Percutaneous Endoscopic Gastrostomy (PEG) placements in the UK are currently 6500 vs 17 000 in 2010 (p<0.01). There is a dedicated PEG consultant involved in 59% of the centres versus 30% in 2010 (p<0.001). Multidisciplinary team meeting (MDT) discussion occurs in 66% versus 40% in 2010 (p<0.05). Formal aftercare provision occurs in 83% versus 64% in 2010 (p<0.001). 74/107 respondents (69%) reported feeling pressurised to authorise a gastrostomy.ConclusionThis national survey, validated by the results from NED, demonstrates a reduction of over 60% for PEG insertion rates compared with previous estimates. There has also been an increase in consultant involvement, MDT discussion and aftercare provision. However, two-third of responders described ‘pressure’ to insert a gastrostomy. Perhaps further efforts are needed to include and educate other specialty teams, patients and next of kin.

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Healthcare professionals' attitudes towards PEG tube feeding in advanced dementia: time to engage with a wide clinical audience?

Cited by 2 publications

References 5 publications

Cui bono? PEG feeding

Cui bono? PEG feeding

What is the current provision of service for gastrostomy insertion in England?

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