Introduction A percutaneous endoscopic gastrostomy (PEG) may be used to provide enteral nutrition to patients, when oral intake is inadequate. Evidence supports PEG feeding in patients with stroke and oropharyngeal malignancy, however no benefit has been shown in patients with advanced dementia. This study examines attitudes of healthcare professionals towards PEG insertions and whether decisions reflect current evidence.
Method Consultant physicians, GPs, Nurses, Speech and language therapists (SLT), Dietitians, Junior doctors and Student doctors and nurses were invited to complete a questionnaire pertaining to four clinical cases: advanced dementia, advanced cancer with poor oral intake, dysphagic stroke and prophylactic PEG in head and neck cancer. Appropriateness of PEG insertion was questioned for these devised cases and rationale for insertion determined.
Results 426/684 (62%) questionnaires were returned. 13% of participants had previously received teaching about PEG feeding. Table 1shows the proportion of healthcare professionals who would initiate feeding for each case.
Consultants, dietitians and SLTs were less likely to feed in advanced dementia than nurses or students (p < 0.0001), with poor prognosis and increased complications being the main rationale. 40% of all participants felt PEG insertion would prevent aspiration pneumonia in advanced dementia. In both dysphagic stroke and head and neck cancer cases, qualified staff were more likely to insert PEGs compared to students (p < 0.0001), with perceived improvements in nutritional status and quality of life influencing the decision-making.
Conclusion This study demonstrates that healthcare professionals have variable knowledge about the evidence base supporting gastrostomy feeding. Furthermore, we demonstrate teaching in this important area is limited. Given the increased frequency of PEG insertions, we advocate enhancing education of PEG feeding in both undergraduate and postgraduate training programmes, thereby hopefully improving patient selection.
Disclosure of interest None Declared.
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