Clinician's Attitude to Enteral Nutrition with Percutaneous Endoscopic Gastrostomy: A Survey in China

Abstract

Background: Percutaneous endoscopic gastrostomy (PEG) are recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians’ opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding.Methods: A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses.Results: Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p=0.000). Overall, 241 (46%) participants do not know PEG and 284 (54%) have different understanding degree of PEG. Age (p=0.002), working life (p=0.044) and professionalism (p=0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The listed factors influencing physicians' choice of PEG for long-term feeding scored high for all items, ranging from 3.57 to 3.89. Conclusions: Doctors’ insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among healthcare professionals (HCPs) and between departments, and a crisis of doctor-patient trust all influence the medical decision-making process, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.