The Feeding Issues Multidisciplinary Team – effect on selection and outcome of patients referred for Percutaneous Endoscopic Gastrostomy in a tertiary referral centre in the UK

Abstract

Background Decisions relating to artificial nutrition support are often complex. In 2006, a multi-professional committee was set up in Addenbrooke's Hospital chaired by a palliative care physician in view of the importance of end of life care in many feeding decisions. Similarly, elderly care medicine and gastroenterology are represented at senior level, with speech and language therapists, dieticians, nutrition support and endoscopy nurses also present. This study aims to determine the effect of the Feeding Issues Multidisciplinary Team (FIMDT) on patient selection and outcome. Methods A retrospective analysis of patient records was performed on all patients receiving Percutaneous Endoscopic Gastrostomy (PEG) in the periods before and after the institution of the FIMDT (2001-2009). Reasons for patients not receiving PEG after discussion at the FIMDT were documented. Statistical significance was analysed by student t-test. Results 308 patients from the Pre-FIMDT period and 388 patients from the post-FIMDT period were included. 261/388 patients (Male -61%, Female - 39%; average age - 60 years) from the post-FIMDT period (74/year) had PEG compared to 308 patients (Male - 52%, Female - 48%; average age - 63 years) in the Pre- FIMDT period (68/year). The common indications were stroke, neurodegenerative diseases and head and neck cancers (Pre-FIMDT 33%, 22%, 18% vs. post-FIMDT 16%, 18%, 32% respectively). The cumulative mortality at one, three, six and twelve months post-PEG was 7%, 19%, 27% and 40% in the pre-FIMDT period compared to 5%, 14%, 20% and 30% respectively in the post-FIMDT period. The reduction in mortality at six and twelve months was statistically significant (p value 0.03 and 0.01). The reduction in cumulative mortality was highest for stroke patients (Pre-FIMDT 14%, 47%, 73%, 100% vs. Post-FIMDT 6%, 19%, 28%, 36% at one, three, six and twelve months respectively). Of the 127/388 patients referred to FIMDT who did not have a PEG, 55 were not indicated, 24 were unfit, 23 were referred for Radiologically Inserted Gastrostomy (RIG)and 25 were appropriate but did not receive a PEG due to technical difficulty, refusal, or death. Therefore 102/388 (26%) patients originally referred to the FIMDT were deemed inappropriate. Conclusion The FIMDT resulted in a more selected population for PEG placement with an associated significant reduction in cumulative mortality at 6 months and 12 months. This was most pronounced among stroke patients.