RT Journal Article
SR Electronic
T1 Should they have a percutaneous endoscopic gastrostomy? The importance of assessing decision-making capacity and the central role of a multidisciplinary team
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 245
OP 249
DO 10.7861/clinmedicine.14-3-245
VO 14
IS 3
A1 Gemma Clarke
A1 Sarah Galbraith
A1 Jeremy Woodward
A1 Anthony Holland
A1 Stephen Barclay
YR 2014
UL http://www.rcpjournals.org/content/14/3/245.abstract
AB Decisions about percutaneous endoscopic gastrostomy (PEG) can be clinically and ethically challenging, particularly when patients lack decision-making capacity. As the age of the UK population rises, with the associated increase in prevalence of dementias and neurodegenerative diseases, it is becoming an increasingly important issue for clinicians. The recent review and subsequent withdrawal of the Liverpool Care Pathway highlighted feeding as a particular area of concern. The authors undertook a 1-year retrospective review of individuals referred to the feeding issues multidisciplinary team (FIMDT) at Addenbrooke's Hospital, Cambridge, UK, in 2011. The majority of patients referred (n = 158) had a primary diagnosis of cancer (44%). The second largest group was those who had had a stroke or brain haemorrhage (13%). Twenty-eight per cent of patients had no, or uncertain, decision-making capacity on at least one occasion during decision-making. There are reflections on the role of a multidisciplinary team in the process of decision-making for these complex patients.