Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting.

J Am Geriatr Soc

Indiana University Center for Aging Research, Regenstrief Institute for Health Care, Indianapolis 46202-2859, USA.

Published: September 1999

Objective: To describe clinical decision-making for percutaneous endoscopic gastrostomy from the perspective of patients, caregivers, and physicians.

Design: A prospective cohort study.

Setting And Patients: All patients aged 60 and older receiving percutaneous endoscopic gastrostomies in a defined community over a 16-month period.

Main Outcomes Measures: Either patients or their surrogate decision-makers completed a semistructured face-to-face interview to map out the information gathering process, expectations, and discussants involved in the decision to proceed with gastrostomy feeding. Physicians completed a written questionnaire to determine their likelihood of recommending percutaneous endoscopic gastrostomy, their involvement in the decision-making and recommendation process, and sources of perceived pressure in the decision-making.

Results: We identified 100 patients who received percutaneous endoscopic gastrostomy during the study window and 82 primary care physicians who provided care in the defined community. The most common reasons for the procedure were stroke, neurologic disease, and cancer. Patients or their surrogate decision-makers reported multiple discussants, incomplete information, and considerable distress in arriving at the decision to proceed with artificial feeding. This distress was usually in the context of an acute and debilitating illness that often overshadowed the decision about artificial feeding. The decision for gastrostomy often appeared to be a "non-decision" in the sense that decision-makers perceived few alternatives. Physicians also reported considerable distress in arriving at recommendations to proceed with percutaneous endoscopic gastrostomy, including perceived pressures from families or other healthcare professionals. Physicians have clear patterns of triage for percutaneous endoscopic gastrostomy, but the assumptions underlying these patterns are not well supported by the medical literature.

Conclusions: Patients, caregivers, and physicians are often compelled to make decisions about long-term enteral feeding under tragic circumstances and with incomplete information. Decision-makers typically do not perceive any acceptable alternatives. Because data on these patients' long-term functional outcomes are lacking, decision-makers appear to focus primarily on the short-term safety of the procedure and the potential for improved nutrition.

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1532-5415.1999.tb05235.xDOI Listing

Publication Analysis

Top Keywords

percutaneous endoscopic
28
endoscopic gastrostomy
24
decision-making percutaneous
8
gastrostomy
8
patients caregivers
8
defined community
8
patients surrogate
8
surrogate decision-makers
8
decision proceed
8
considerable distress
8

Similar Publications

Introduction: The US supply disruption of surgical irrigation fluids in September 2024 prompted the need for fluid conservation and potential deferral of urology procedures. We characterized fluid use in common endoscopic procedures to articulate recommendations for irrigation fluid stewardship and case prioritization during fluid shortages.

Methods: We reviewed case volumes and irrigation fluid use for endoscopic urological procedures at our institution during January-September 2024.

View Article and Find Full Text PDF

In this study, we investigated the effect of severe dysphagia on the overall survival of patients who underwent PEG. A cohort of patients who underwent PEG between April 2016 and April 2021 was retrospectively analyzed. The Hyodo-Komagane score was used to evaluate swallowing via endoscopy.

View Article and Find Full Text PDF

Background: Malignant obstructive jaundice (MOJ) is characterized by the presence of malignant tumors infiltrating or compressing the bile duct, causing poor bile drainage, generalized yellowing, pain, itching, and malaise. MOJ is burdensome for both the society and the families of affected patients and should be taken seriously.

Aim: To evaluate the clinical effect of stent placement during endoscopic retrograde cholangiopancreatography for relieving MOJ and the efficacy of percutaneous transhepatic biliary drainage in terms of liver function improvement, complication rates, and long-term patient outcomes.

View Article and Find Full Text PDF

Background: One-hole split endoscopy (OSE) is a novel endoscopic technique that offers some advantages in spinal surgery. However, without a clear understanding of the safe zone for OSE, surgeons risk injuring nerve roots during the procedure. This study aimed to measure the safe distances among critical bone markers, the intervertebral space and nerve roots between 1-degree degenerative lumbar spondylolisthesis (DLS) and non-DLS at the L segment in patients via three-dimensional reconstruction and to compare the differences in relevant safety distances between the two groups.

View Article and Find Full Text PDF

Objective: To explore the efficacy and safety of the direct inferior endplate approach in percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of L5-S1 disc herniation.

Methods: This was a retrospective analysis of 116 patients with L5-S1 disc herniation treated with PEID; 74 patients underwent surgery via the direct inferior endplate approach (group A), and 42 patients underwent surgery via the indirect approach (group B). The number of intraoperative fluoroscopy exposures, establishment channel time, operation time, postoperative visual analogue scale (VAS) score, and Oswestry Disability Index (ODI) were compared between the 2 groups.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!