title: Family Experiences With Feeding Tubes in Neurologic Impairment: A Systematic Review.
abstract: OBJECTIVE
  Gastrostomy tubes (G-tubes) are frequently used to provide enteral nutrition for children who have neurologic impairment. Understanding the impact of G-tubes from the family's perspective will inform decision-making and improve support from health care providers. This study explored the experiences of families after G-tube placement in children with neurologic impairment.
  
  
  METHODS
  We conducted a systematic review of English-language qualitative primary research studies describing family experiences after G-tube placement. Six electronic databases were searched from inception to June 2014. Two authors independently screened and identified relevant studies, evaluated quality of reporting by using the Consolidated Criteria for Reporting Qualitative Research tool, and extracted data. Overarching concepts were developed by using thematic analysis.
  
  
  RESULTS
  From 2674 screened abstracts, 84 texts were reviewed, and 13 studies met the inclusion criteria. G-tubes affect the lives of children, parents, and the family unit in many ways, both positive and negative. Improvements and challenges were described for children's health and happiness, for parental caregiving and stress, and for logistics and bonding within the family. G-tube feeding also changed relationships within the family, between the family and the medical system, and between the family and the outside world. Furthermore, experiences varied, with different families framing similar concepts as positive and negative.
  
  
  CONCLUSIONS
  G-tube placement has diverse effects on daily life for children with neurologic impairment and their families. Clinicians may use the themes identified in this study to guide conversations with families about their values, experiences, and expectations before and after G-tube placement.
authors.affiliation: Paediatric Advanced Care Team and Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, katherine.nelson@sickkids.ca.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Nelson
authors.affiliation: Factor-Inwentash Faculty of Social Work, and.
authors.forename: Ashley
authors.initials: A
authors.lastname: Lacombe-Duncan
authors.affiliation: Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada; and.
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.affiliation: Department of Social Work, University of Calgary, Calgary, Alberta, Canada.
authors.forename: David B
authors.initials: DB
authors.lastname: Nicholas
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rosella
authors.affiliation: Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada;
authors.forename: Astrid
authors.initials: A
authors.lastname: Guttmann
authors.affiliation: Division of Paediatric Medicine, Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, CanChild Centre for Childhood Disability Research, Hamilton, Ontario, Canada; and.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
mesh_terms: D002648:Child; D003657:Decision Making; D004750:Enteral Nutrition / Q000379:methods*; D005190:Family; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*