How are decisions made about the use of percutaneous endoscopic gastrostomy for long-term nutritional support?
OBJECTIVE: We sought to study the process by which decisions to commit individuals to long-term nutritional support via percutaneous endoscopic gastrostomy (PEG) are made. METHODS: A semistructured questionnaire was administered to surrogates and patients in 73 cases of persons undergoing PEG. RESULTS: Such decisions are often made with inadequate information regarding the PEG and its possible impact on the future clinical course, sometimes with an overly optimistic view of the prognosis. Several factors may influence this process. In cases in which the underlying illness was severe, 30% of surrogate decisionmakers expressed some uncertainty that a right decision was made. CONCLUSIONS: The decision to commit patients to long-term nutritional support via PEG is often difficult and the implications of such a commitment may have major implications for patients and their families. Strategies to optimize this decisionmaking process are recommended.
