Should they have a percutaneous endoscopic gastrostomy? the importance of assessing decision-making capacity and the central role of a multidisciplinary team.

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Clarke, Gemma 
Galbraith, Sarah 
Woodward, Jeremy 

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.

Percutaneous endoscopic gastrostomy, decision-making capacity, feeding issues multidisciplinary team, Aged, Decision Making, Decision Support Techniques, Female, Gastroscopy, Gastrostomy, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures, Neoplasms, Neurodegenerative Diseases, Patient Care Team, Retrospective Studies, United Kingdom
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Clin Med (Lond)
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Royal College of Physicians