Health care professionals' knowledge about percutaneous gastrostomy feeding. How well are we doing?

Abstract

Introduction: There is a reasonable body of evidence to support the use of percutaneous gastrostomy (PEG) feeding for stroke patients, but no evidence to support this practice in advanced dementia. A previous study showed that 34% of UK consultants would refer a patient with dementia for a PEG.1 In the light of the new Mental Capacity Act it is vital that healthcare professionals are able to make evidence-based decisons and advise patients and families appropriately. Aims and Methods: We were keen to explore healthcare professionals' knowledege about PEG feeding. We were also keen to identify whether teaching had any influence on knowledge. A simple questionnaire was given to a range of healthcare professionals in four hospitals across the midlands and to an expert group (Midlands Gastroenterogy Group). Participants were asked about two scenarios of dysphagic stroke and advanced dementia. They were also asked if they had received any teaching and how much relevant experience they had. Results: 556 of 714 questionnaires were collected (78%) from hospital doctors of all levels and general practitioners (GPs), medical students, nurses and dieticians. More respondents answered questions about dysphagic stroke correctly compared with dementia. Only 10% of hospital consultants would refer the dementia patient for a PEG compared with 31% of GPs, 37% of F1/F2 doctors, 36% of medical students and 45% of nurses. Only 29% of all respondents felt that PEG would prevent aspiration pneumonia in the dementia patient (although nurses' opinion was split 45% vs 45%). 20% of respondents felt PEG would improve life expectancy. Dieticians as a group were most likely to answer questions correctly. 64% of respondents had experience with similar patients including 77% of GPs and 69% of foundation doctors. Teaching significantly influenced answers for the dementia scenario (p=0.001). Only 29% had received teaching and only 4% of GPs had attended relevant teaching. Experts were more likely to answer correctly (p=0.004). Conclusion: Despite improvements in consultants' knowledge compared with previous studies, there are still significant gaps in knowledge. Training improves knowledge and this study suggests more teaching should be planned, particularly aimed at nurses, medical students, junior doctors and GPs.