"In your best interest"; Exploring outcomes of percutaneous endoscopic gastrostomy tubes following strokes when the decision was made in best interest and consented.
Gibson, E Murandu, M
Gibson, E
Murandu, M
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Affiliation
The Dudley Group NHS Foundation Trust; Wolverhampton University
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2024-10-18
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Abstract
Stroke can necessitate a Percutaneous Endoscopic Gastrostomy (PEG) tube. Patients can be incapacitated as per Mental Capacity Act 2005 resulting in a best interest decision (BID). This is a complex decision due to the unknown prognosis (Frey et al 2020) and requires assessment of whether a BID changes the outcome of PEG. A retrospective exploratory observational design was utilised. All PEGs inserted between 2020-2023 in a NHS Trust identified through a review of electronic records. The collection tool was developed for this study and the data analysed using SPSS. Ethical approval was granted by University of Wolverhampton and authorised by Dudley Group NHS Foundation Trust R & D. IRAS 331753. 36 data sets were analysed: 16 consented (CS) and 20 BIDs equalling 55.56% incapacitated. The mean survival days in consented is 271.3 (P=.001, standard deviation (SD) 138.0) and BID is 245.8 (P=.001, SD 141.3) giving a 25.6-day difference. A Cohen's d with hedges correction for BID with lower correction was 0.98 (CI 95%), and for CS it is 1.04. This is magnified to BID 2.33 and CS 2.66 (CI 95%) when using the upper interval data. The results suggest that the complexities of BIDs may impact survival length. No previous research has separated the groups when calculating survival. The limitations of small sample size and consecutive sampling reduces the generalisability of these results therefore a larger study is recommended. References: Mental capacity Act 2005, c.9. Available at: www.legislation.gov.uk/ukpga/2005. (Accessed 20th March 2023). Frey, I., De Boer,E., Dronkert, L., Pols, J., Visser, C., Hertogh, M., and Depla, A. (2020) 'Between Choice, Necessity, and Comfort: Deciding on Tube Feeding in the Acute Phase After a Severe Stroke'. Qualitative Health Research, 30(7), pp.1114-1124. Doi:10.1177/1049732320911376
Citation
E. Gibson, M. Murandu, �In your best interest�; Exploring outcomes of percutaneous endoscopic gastrostomy tubes following strokes when the decision was made in best interest and consented, Clinical Nutrition ESPEN, Volume 63, 2024, Pages 1251-1252,