Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study

Abstract

Peer reviewed versionCyswllt i'r cyhoeddiad / Link to publication Dyfyniad o'r fersiwn a gyhoeddwyd / Citation for published version (APA): Singh Curry, R., Evans, E., Raftery, A-M., Hiscock, J., & Poolman, M. (2019). Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study. BMJ Supportive and Palliative Care, 9(4), 381-388. https://doi. Abstract ObjectiveMalignant Bowel Obstruction (MBO) is a complication of advanced malignancy and is associated with a short prognosis. MBO can infrequently be reversed by surgery or stenting. The focus of treatment is usually symptomatic management, of which percutaneous venting gastrostomy/gastrojejunostomy (PVG) is one consideration. There is little data considering the impact of PVG on quality of life; we therefore aimed to explore this. MethodsWe identified patients with PVG inserted for MBO and those who consented to participate were interviewed. The interviews were audio-recorded, transcribed and analysed using Framework. Alongside patient interviews, a data collection tool was designed and utilised to record patient demographics and medical information, enabling us to contextualise individual patients' experiences.Results 11 patients were interviewed and 10 patients' data was analysed (1 patient withdrew). No patients regretted having a PVG and many benefitted symptomatically and psychosocially. Challenges encountered included practical issues, pain and PVG tube complications. ConclusionsThe analysis provided a detailed insight into the impact of PVG insertion and demonstrated that each patients' experience is shaped by a complex interplay of individual factors, thereby highlighting the need to improve referral criteria and individualise patient selection. Other service improvements include enhancing information provision for patients and training for Healthcare Professionals', thus aiming to mitigate the challenges experienced. Our study is the first in-depth exploration of patients' experiences of PVG at a tertiary cancer centre. Ensuring that the insights from this study are fed back to guide future service provision is critical in enhancing future patient experiences.

Endoscopic management of enteral tubes in adult patients – Part 1: Definitions and indications. European Society of Gastrointestinal Endoscopy (ESGE) Guideline

“…Decompression (venting) gastrostomy may be required for patients with bowel obstruction, in order to decompress the GI tract from the build-up of digestive secretions and gaseous distension [31,32]. While malignant bowel obstruction is often encountered in patients with ovarian or colon cancer [32,33], benign conditions include chronic intestinal pseudo-obstruction [34] and gastroparesis with advanced symptoms [35].…”

Symptom burden and lived experiences of patients, caregivers and healthcare professionals on the management of malignant bowel obstruction: A qualitative systematic review

“…I was so grateful for that because it was just projectile all the time.” Patient, page 385 . 30 Another positive aspect of percutaneous venting gastrostomy/gastrojejunostomy insertion was that the nasogastric tube could be removed, thereby improving body image and comfort: “I hated that up my nose because it was so uncomfortable. It hurt me.…”

“….” Patient, page 386 . 30 One patient described the ‘freeing’ sensation, when for brief periods, they could remove all the tubes they were attached to: “When I go in the shower and everything I can. .…”

“…This included a profound loss of normality, limited bodily freedom and energy: “It’s difficult, yeah, especially going upstairs, because I’ve not got much energy.” Patient, page 6 , 31 imposed routine and invasion of medical environment into the home. 30 One patient described the experience as more difficult than they anticipated: “It wasn’t as easy as it was made out to be.” Patient, page 7 . 31 …”

“….” Patient, page 386 . 30 Patients also described unrealistic expectations for the intervention, believing percutaneous venting gastrostomy/gastrojejunostomy would lead to full resolution of symptoms, a return to normal eating and prolonged life expectancy. 30 …”