title: Percutaneous endoscopic gastrostomy in hospitalized incompetent geriatric patients: poorly informed, constrained and paradoxical decisions.
abstract: BACKGROUND
  The frequency of performing percutaneous endoscopic gastrostomy in demented older people has increased in recent years. Several reports indicate flaws in the criteria for performing PEG and in the decision-making process, raising concerns about the adequacy of the consent.
  
  
  OBJECTIVE
  To assess the knowledge and attitudes of referring doctors and gastroenterologists, and to evaluate attitudes and feelings of family members concerning PEG insertion.
  
  
  METHODS
  We conducted a survey of 72 doctors who referred 126 demented patients for PEG, as well as 126 family members and 34 gastroenterologists. Closed-ended questionnaires were designed for each study group, completed by the participants, and computer analyzed.
  
  
  RESULTS
  Approximately 50% of family members expressed dissatisfaction with the decision-making process. Referring physicians reported that PEG insertion was often dictated by the need to transfer patients to a nursing home, with 50% admitting institutional pressure. Most of the referring physicians believed that PEG improved quality of life and increased longevity, whereas gastroenterologists did not expect an improved quality of life and thought that administrative demands should not intervene in the decision to insert PEG.
  
  
  CONCLUSIONS
  The decision-making process in the patient's families regarding PEG insertion for their demented relative is unsatisfactory, often takes place under pressure, and does not provide sufficient information about the procedure or its complications. Interpersonal communication between the patient's family and the medical team needs to be improved, and institutional demands should not play a major role in the medical decision to insert PEG. Gastroenterologists should take a more active role in the deliberations regarding PEG.
authors.affiliation: Department of Gastroenterology, Hadassah University Hospital, Jerusalem, Israel. ilana_g5@walla.com
authors.forename: Ilana
authors.initials: I
authors.lastname: Golan
authors.forename: Moshe
authors.initials: M
authors.lastname: Ligumsky
authors.forename: Mayer
authors.initials: M
authors.lastname: Brezis
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D003657:Decision Making; D003704:Dementia / Q000150:complications*; D005260:Female; D005773:Gastroscopy / Q000941:ethics*; D005774:Gastrostomy / Q000941:ethics*; D006801:Humans; D007258:Informed Consent / Q000941:ethics*; D007557:Israel; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D011788:Quality of Life; D012017:Referral and Consultation; D011795:Surveys and Questionnaires