Abstract
Objective
To explore the perceptions of healthcare professionals’ (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding.
Design
Semi-structured, qualitative interviews.
Settings
A teaching hospital in Kuala Lumpur, Malaysia.
Participants
A total of 17 healthcare professionals aged 23-43 years, 82% women.
Results
Thematic analysis revealed five themes that represent HCPs’ perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability.
Conclusion
The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.
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References
Paciaroni M, Mazzotta G, Corea F, Caso V, Venti M, Milia P, et al. Dysphagia following Stroke. Eur Neurol; 2004; 51(3): 162–7.
Turley R, Cohen S. Impact of voice and swallowing problems in the elderly. Otolaryngol Head Neck Surg; 2009,140(1):33–6.
Zaherah Mohamed Shah F, Suraiya HS, Poi PJ, Tan KS, Lai PS, Ramakrishnan K, et al. Long-term nasogastric tube feeding in elderly stroke patients—an assessment of nutritional adequacy and attitudes to gastrostomy feeding in Asians. J Nutr Health Aging;2012; 16(8): 701–6.
Lin LC, Wu SC, Chen HS, Wang TG, Chen MY. Prevalence of impaired swallowing in institutionalized older people in taiwan. J Am Geriatr Soc; 2002; 50(6): 1118–23.
Cabre M, Serra-Prat M, Palomera E, Almirall J, Pallares R, Clave P. Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. Age Ageing; 2010; 39(1): 39–45.
Ney DM, Weiss JM, Kind AJ, Robbins J. Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract; 2009; 24(3): 395–413.
Serra-Prat M, Palomera M, Gomez C, Sar-Shalom D, Saiz A, Montoya JG, et al. Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study. Age Ageing; 2012; 41(3): 376–81.
Middleton MH, Nazarenko G, Nivison-Smith I, Smerdely P. Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals. Intern Med J; 2001; 31(8): 455–61.
Kreymann KG, Berger MM, Deutz NEP, Hiesmayr M, Jolliet P, Kazandjiev G, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr; 2006; 25(2): 210–23.
Stroud M, Duncan H, Nightingale J. Guidelines for enteral feeding in adult hospital patients. Gut; 2003;52(suppl 7):vii1–vii12.
Dwolatzky T, Berezovski S, Friedmann R, Paz J, Clarfield AM, Stessman J, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr; 2001; 20(6): 535–40.
Sadasivan A, Faizal B, Kumar M. Nasogastric and percutaneous endoscopic gastrostomy tube use in advanced head and neck cancer patients: A comparative study. J Pain Palliat Care Pharmacother; 2012; 26(3): 226–32.
Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Med J Malaysia; 2006; 61(1): 59–66.
Kwong JPY, Stokes EJ, Posluns EC, Fitch MI, McAndrew A, Vandenbussche KA. The experiences of patients with advanced head and neck cancer with a percutaneous endoscopic gastrostomy tube: A qualitative descriptive study. Nutr Clin Pract; 2014; 29(4): 526–33.
Kumagai R, Kubokura M, Sano A, Shinomiya M, Ohta S, Ishibiki Y, et al. Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia. Psychiatry Clin Neurosci; 2012; 66(5): 418–22.
Gomes CA, Lustosa SA, Matos D, Andriolo RB, Waisberg DR, Waisberg J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev; 2012;3:CD008096.
Lin LC, Li MH, Watson R. A survey of the reasons patients do not chose percutaneous endoscopic gastrostomy/jejunostomy (peg/pej) as a route for long-term feeding. J Clin Nurs 2011;20(5/6):802–10.
Jaafar MH, Mahadeva S, Tan KM, Tan MP. Attitudes of Health Care Professionals Towards Gastrostomy Feeding in Older Adults in Malaysia. Int J Gerontol; 2015; 9(1): 40–5.
Madigan SM, Fleming P, McCann S, Wright ME, MacAuley D. General Practitioners involvement in enteral tube feeding at home: a qualitative study. BMC Fam Pract; 2007;8:29.
Bjuresäter K, Larsson M, Nordström G, Athlin E. Cooperation in the care for patients with home enteral tube feeding throughout the care trajectory: nurses’ perspectives. J Clin Nurs; 2008; 17(22): 3021–9.
Brotherton A, Abbott J. Clinical decision making and the provision of information in PEG feeding: an exploration of patients and their carers’ perceptions. J Hum Nutr Diet; 2009; 22(4): 302–9.
Bryon E, Gastmans C, de Casterle BD. Nurse-physician communication concerning artificial nutrition or hydration (ANH) in patients with dementia: a qualitative study. J Clin Nurs; 2012;21(19pt20):2975–84.
Polit DF, Beck CT. Essentials of Nursing Research: Appraising evidence for nursing practice. Burns CC, Reilly D, editors. Philadelphia, PA.: Wolters Kluwer Health/Lippincott Williams & Wilkins. 2010; 512 p.
Gubrium JF, Holstein JA. The New Language of Qualitative Method. 198 Madison Avenue, New York: Oxford University Press, Inc. 1997;256 p.
Yeh L, Lo L, Fetzer S, Chen C. Limited PEG tube use: the experience of long-term care directions. J Clin Nurs; 2010;19(19/20):2897–906.
Adams KM, Kohlmeier M, Powell M, Zeisel SH. Nutrition in medicine: nutrition education for medical students and residents. Nutr Clin Pract; 2010; 25(5): 471–80.
Todd V, van Rosendaal G, Duregon K, Verhoef M. Percutaneous endoscopic gastrostomy (PEG): the role and perspective of nurses. J Clin Nurs; 2005; 14(2): 187–94.
Healy S, McNamara E. Tube feeding controversial patients: what do dietitians think? J Hum Nutr Diet; 2002; 15(6): 445–53.
Yip K, Rai V, Wong K. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiol; 2014; 14(1): 1–5.
Xu XL, Zhou JC, Pan KH, Zhao HC, Ying KJ. Attitudes toward the American nutrition guidelines for the critically ill patients of Chinese intensive care physicians. Asia Pac J Clin Nutr; 2015; 24(2): 347–58.
Wei J, Chen W, Zhu M, Cao W, Wang X, Shi H, et al. Guidelines for parenteral and enteral nutrition support in geriatric patients in China. Asia Pac J Clin Nutr; 2015; 24(2): 336–46.
Kobayashi N. Guidelines for the use of parenteral and enteral nutrition. Nihon Rinsho; 2001;59 Suppl 5:45–8.
Propp KM, Apker J, Zabava Ford WS, Wallace N, Serbenski M, Hofmeister N. Meeting the complex needs of the health care team: identification of nurse-team communication practices perceived to enhance patient outcomes. Qual Health Res; 2010; 20(1): 15–28.
Carmel S. Life-sustaining treatments: what doctors do, what they want for themselves and what elderly persons want. Soc Sci Med; 1999; 49(10): 1401–8.
McDonagh JR, Elliott TB, Engelberg RA, Treece PD, Shannon SE, Rubenfeld GD, et al. Family satisfaction with family conferences about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Crit Care Med; 2004; 32(7): 1484–8.
Oberle K, Hughes D. Doctors’ and nurses’ perceptions of ethical problems in end-oflife decisions. J Adv Nurs; 2001; 33(6): 707–15.
Puntillo KA, McAdam JL. Communication between physicians and nurses as a target for improving end-of-life care in the intensive care unit: challenges and opportunities for moving forward. Crit Care Med; 2006;34(11 Suppl):S332–40.
Cahill NE, Murch L, Cook D, Heyland DK. Barriers to feeding critically ill patients: A multicenter survey of critical care nurses. J Crit Care; 2012; 27(6): 727–34.
Claramita M, Nugraheni MD, van Dalen J, van der Vleuten C. Doctor-patient communication in Southeast Asia: a different culture? Adv Health Sci Educ Theory Pract; 2013; 18(1): 15–31.
Baker R, Wu AW, Teno JM, Kreling B, Damiano AM, Rubin HR, et al. Family satisfaction with end-of-life care in seriously ill hospitalized adults. J Am Geriatr Soc. May; 2000;48(5 Suppl):S61–9.
Mitchell SL, Berkowitz RE, Lawson FM, Lipsitz LA. A cross-national survey of tube-feeding decisions in cognitively impaired older persons. J Am Geriatr Soc.Apr; 2000; 48(4): 391–7.
Conron M, Phuah S, Steinfort D, Dabscheck E, Wright G, Hart D. Analysis of multidisciplinary lung cancer practice. Intern Med J; 2007; 37(1): 18–25.
Lamb BW, Jalil RT, Sevdalis N, Vincent C, Green JS. Strategies to improve the efficiency and utility of multidisciplinary team meetings in urology cancer care: a survey study. BMC Health Serv Res; 2014;14:377.
Mahadeva S, Khoo B-L, Khoo P-S, Malik A, Hilmi I, Qua C-S, et al. Clinical impact and risk factors for percutaneous gastrostomy wound infections due to resistant organisms. Int J Infect Dis; 2008;12(6):e149–e50.
Subramaniam S. Private healthcare facilities and services (private hospitals and other private healthcare facilities)(amendment) order 2013. Malaysia: Attorney General’s Chambers, 2013.
Kananatu K. Healthcare financing in Malaysia. Asia Pac J Public Health; 2002; 14(1): 23–8.
Ojo O. The Challenges of Home Enteral Tube Feeding: A Global Perspective. Nutrients; 2015; 7(4): 2524–38.
Smith T. Annual BANS Report, 2011: Artificial Nutrition Support in the UK 2000-2011. Redditch, Worcs: BAPEN, 2011.
Elia M. An international perspective on artificial nutritional support in the community. Lancet; 1995; 345(8961): 1345–9.
Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, et al. Health-financing reforms in southeast Asia: challenges in achieving universal coverage. Lancet; 2011; 377(9768): 863–73.
Rechel B, Grundy E, Robine J-M, Cylus J, Mackenbach JP, Knai C, et al. Ageing in the European Union. Lancet; 2013; 381(9874): 1312–22.
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Jaafar, M.H., Mahadeva, S., Subramanian, P. et al. Perceptions of healthcare professionals on the usage of percutaneous endoscopic gastrostomy in a teaching hospital from a middle-income South East Asian country. J Nutr Health Aging 21, 473–479 (2017). https://doi.org/10.1007/s12603-016-0774-2
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DOI: https://doi.org/10.1007/s12603-016-0774-2