Department of Nutrition Services, University of Virginia Health System, Charlottesville, VA, 22903, USA.
Morrison Healthcare, University of Virginia Health System, Charlottesville, VA, 22903, USA.
Surg Endosc. 2019 Dec;33(12):4089-4097. doi: 10.1007/s00464-019-06711-3. Epub 2019 Feb 26.
Percutaneous endoscopically placed gastrostomy (PEG) tubes are useful for long-term enteral nutrition; however, they are associated with lack of benefit for patients with advanced dementia, at end of life, and for some stroke patients with early regain of swallowing function. We surveyed physician opinions on decision making with the aim to identify factors that can lead to inappropriate PEG placement, as a first step of a quality improvement initiative to prevent inappropriate PEG placements at our facility.
A survey was distributed to 231 physicians, with questions about discussion topics, contraindications, responsibilities, and practices in decision making for PEG placement. Five-point Likert scales were used for most responses.
Of 62 respondents, the majority were general surgeons (51.6%) and neurologists (30.6%). Levels of agreement were very low that PEG placement is contraindicated in advanced dementia (> 56% disagreed) and at end of life (55% disagreed) with scores of 2.4 and 2.5 (out of 5), respectively. Agreement level was low (score of 2.85) for delaying PEG for stroke patients by at least 2 weeks. Agreement was high for the discussion topics, for allowing 1-7 days for processing information, and for consulting the nutrition service. Over 98% of respondents chose primary team and 58% chose both primary and endoscopy teams as being responsible for discussions with patients and care partners in the decision-making process.
Greater awareness is needed of the lack of benefit of PEG feeding in advanced dementia, at end of life, and for some stroke patients with early regain of swallow function. Disagreement exists as to whether the primary team and endoscopist share in the responsibility for discussions in decision making for PEG placement.
经皮内镜下胃造口术（PEG）管对于长期肠内营养很有用；然而，对于终末期的晚期痴呆患者、以及一些吞咽功能早期恢复的脑卒中患者，它们的获益并不明确。我们调查了医生在决策方面的意见，旨在确定导致 PEG 不当放置的因素，作为我们机构质量改进计划的第一步，以防止 PEG 不当放置。
我们向 231 名医生发放了一份调查问卷，其中包括关于 PEG 放置决策的讨论话题、禁忌证、责任和实践等问题。大多数回答都使用了 5 分李克特量表。
在 62 名回复者中，大多数是普通外科医生（51.6%）和神经科医生（30.6%）。在 PEG 放置的禁忌证方面，大多数人认为在晚期痴呆症（>56%的人不同意）和生命末期（55%的人不同意）的情况下，PEG 放置是不合适的，其得分分别为 2.4 和 2.5（满分 5 分）。对于脑卒中患者，至少推迟 2 周进行 PEG 的做法，其同意程度较低（得分 2.85）。在讨论话题、允许 1-7 天处理信息和咨询营养服务方面，医生的意见较为一致。超过 98%的医生选择由主要治疗团队，而 58%的医生选择主要治疗团队和内镜团队共同负责决策过程中与患者和护理人员的讨论。
需要提高对晚期痴呆症、生命末期以及一些吞咽功能早期恢复的脑卒中患者进行 PEG 喂养缺乏获益的认识。对于主要治疗团队和内镜医生是否应共同承担 PEG 放置决策中的讨论责任，存在意见分歧。
