Shega Joseph W, Hougham Gavin W, Stocking Carol B, Cox-Hayley Deon, Sachs Greg A
Department of Medicine, Section of Geriatrics, The University of Chicago, Chicago, Illinois 60637, USA.
J Palliat Med. 2003 Dec;6(6):885-93. doi: 10.1089/109662103322654767.
In advanced dementia, many difficult decisions may arise as the disease progresses, including whether to use feeding by tube. Several recent articles question the benefit of percutaneous endoscopic gastrostomy (PEG) tube placement in persons with advanced dementia. However, patients with advanced dementia are still referred for PEG tubes. This study attempts to understand more about physician decisions to recommend PEG tube placement in patients with advanced dementia.
Mailed survey.
Random sample of 500 physicians from the American Medical Association Masterfile.
Primary care physicians.
Physician knowledge, beliefs, and self-reported practices of PEG tubes in advanced dementia.
Of the 416 eligible participants, 195 completed surveys (response rate of 46.9%). A significant number of physicians believe PEG tubes have the following benefits in advanced dementia: reduce aspiration pneumonia (76.4%), and improve pressure ulcer healing (74.6%), survival (61.4%), nutritional status (93.7%), and functional status (27.1%). Most physicians underestimate 30-day mortality in patients who receive a PEG and more than half of physicians believe PEG tubes in advanced dementia are the standard of care. Also, a majority of physicians believe speech therapists, nurses, and nutritional support teams recommend feeding tubes, which influences their decision to recommend a PEG. Last, almost half of these respondents had a nursing home request PEG tube placement, leading physicians to recommend a PEG.
We find a notable discord between physician opinion, reported practice, and the literature regarding PEG tubes in advanced dementia that reveals some of the barriers to decreasing the referral of these patients for PEG.
在晚期痴呆症中，随着疾病进展可能会出现许多艰难的决策，包括是否使用管饲。最近的几篇文章对晚期痴呆症患者行经皮内镜下胃造口术（PEG）置管的益处提出了质疑。然而，晚期痴呆症患者仍被转诊进行PEG置管。本研究试图更深入地了解医生在晚期痴呆症患者中推荐PEG置管的决策。
邮寄调查。
从美国医学协会主文件中随机抽取500名医生。
初级保健医生。
医生对晚期痴呆症患者PEG置管的知识、信念和自我报告的做法。
在416名符合条件的参与者中，195人完成了调查（回复率为46.9%）。相当数量的医生认为PEG置管在晚期痴呆症中有以下益处：降低吸入性肺炎（76.4%）、促进压疮愈合（74.6%）、提高生存率（61.4%）、改善营养状况（93.7%）和功能状态（27.1%）。大多数医生低估了接受PEG置管患者的30天死亡率，超过一半的医生认为晚期痴呆症患者的PEG置管是护理标准。此外，大多数医生认为言语治疗师、护士和营养支持团队推荐饲管，这影响了他们推荐PEG置管的决策。最后，近一半的受访者表示有养老院要求进行PEG置管，这促使医生推荐PEG置管。
我们发现医生的观点、报告的做法与关于晚期痴呆症患者PEG置管的文献之间存在明显不一致，这揭示了减少这些患者转诊进行PEG置管的一些障碍。
