Factors Influencing Decision Making for Gastrostomy Tube Placement for People Living with Serious Illness: A Scoping Review.

Abstract

Background: Gastrostomy (feeding) tubes are one way of managing swallowing impairments (dysphagia) in patients living with serious illnesses. For patients, families, and health care providers to make well-informed, preference-aligned decisions regarding gastrostomy tube placement, each group must understand the other's goals, concerns, and perspectives. Objective: Thus, the goal of this scoping review is to characterize the factors influencing gastrostomy tube placement decisions for people with serious illnesses. Methods: We first identified relevant studies in a systematic manner, using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow diagram to model our screening process. We then used deductive thematic analysis to describe major themes, reporting the data with descriptive statistics such as percentages. Studies were categorized by their primary participant populations (patients, caregivers, and health care providers), with subthemes organized within the major themes of goals, concerns, considerations, and decisional preferences. Results: When considering gastrostomy tube placement, the top themes for patients were extending life (56% of studies), decisional control (56%), quality of life (48%), physical and social limitations and image (44%) and personal factors (44%). For caregivers, the primary themes were decisional control (71% of studies), extending life (50%), personal factors (50%), maintaining nutrition (43%), and knowledge (43%). Finally, health care providers prioritized decisional control (58% of studies), knowledge (53%), quality of life (47%), extending life (42%), and societal factors (42%). Conclusions: Our results highlight key factors that may help center patient preferences when making gastrostomy tube-related decisions, as well as critical areas where more research is needed to help improve decision-making surrounding gastrostomy tube placement. Providing adequate knowledge and understanding patient preferences is critical for patients to make high-quality medical decisions regarding gastrostomy tubes.