A survey of the reasons patients do not chose percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) as a route for long-term feeding

作者：Lin Li Chan^*; Li Mei Hui; Watson Roger

来源：Journal of Clinical Nursing, 2011, 20(5-6): 802-810.

DOI：10.1111/j.1365-2702.2010.03541.x

• complications
• home enteral tube feeding
• home health care
• nasogastric tube
• percutaneous endoscopic gastrostomy
• prevalence

Aims.
To investigate why patients do not choose percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy as a route for long-term feeding.
Background.
Home enteral tube feeding is well recognised as a valuable therapeutic option for patients requiring nutritional support following discharge from hospital. The number of patients discharged from hospital and receiving home enteral tube feeding increases annually in Taiwan.
Design.
A cross-sectional study.
Method.
Participants (n = 607) were chosen from one free-standing home care agency and three hospital-based home care departments in Taipei. A review of the patients' records to gather demographic data, medical diagnosis, length of home care and length of intubation prior to the home visit was conducted. A face-to-face interview was conducted at the time of the home visit.
Findings.
The prevalence rate of home enteral tube feeding was 70 center dot 3% (n = 427). Of the 427 tube-fed subjects, 93 center dot 4% were fed with a nasogastric tube. The most common reasons for refusing to use percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy were 'too old to suffer from an operation', 'worried about wound infection or leakage after performing percutaneous endoscopic gastrostomy' and 'to keep subjects' body integrity'. Stroke, no dementia, poor activities of daily living and poor cognitive status were significant predictors of being tube-fed, while higher education and better cognitive status were significant predictors of percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy use.
Conclusion.
The reasons patients refused to use percutaneous endoscopic gastrostomy or percutaneous endoscopic jejunostomy reflect the influence of cultural values and the level of patients' education, which home health care nurses need to discuss with patients in detail.
Relevance to clinical practice.
Investigating patients' perspective on the meaning of 'body' in Taiwanese culture and the decision-making processes related to home enteral tube feeding is recommended for nurses to provide better care and support when home enteral tube feeding in an option.

• 出版日期2011-3