title: Should they have a percutaneous endoscopic gastrostomy? the importance of assessing decision-making capacity and the central role of a multidisciplinary team.
abstract: 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.
authors.affiliation: Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK gcc29@medschl.cam.ac.uk.
authors.forename: Gemma
authors.initials: G
authors.lastname: Clarke
authors.affiliation: Department of Palliative Care, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Galbraith
authors.affiliation: Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Woodward
authors.affiliation: Learning Disabilities Research Group, Section of Developmental Psychiatry Department of Psychiatry, University of Cambridge, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Holland
authors.affiliation: The Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Barclay
mesh_terms: D000368:Aged; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D005773:Gastroscopy / Q000941:ethics / Q000379:methods*; D005774:Gastrostomy / Q000941:ethics / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000941:ethics / Q000379:methods*; D009369:Neoplasms / Q000628:therapy; D019636:Neurodegenerative Diseases / Q000628:therapy; D010348:Patient Care Team; D012189:Retrospective Studies; D006113:United Kingdom
keywords: Percutaneous endoscopic gastrostomy; decision-making capacity; feeding issues multidisciplinary team