Practice patterns and perceptions of PEG placement after stroke: a survey of neurologists.

BACKGROUND

PEG (percutaneous endoscopic gastrostomy) tube placement after stroke is a clinically and ethically complex decision. Current evidence does not show a clear benefit of PEG-feeding in improving survival or function after stroke, yet substantial variations exist in clinical practice.

OBJECTIVE

To assess key themes guiding clinician decision-making for PEG-feeding after stroke in clinical practice.

METHODS

A 26-item web-based survey, hosted and distributed on the American Academy of Neurology Synapse Communities platform, was completed by 64 physicians across diverse sub-specialties and practice settings. Descriptive statistics were used to interpret results.

RESULTS

64 survey responses were received, of whom 75% found this issue highly or fairly relevant to their practice. The majority (87.5%) felt that PEG-feeds benefited patients overall, 72% preferred placement 2 weeks after stroke and 78% expressed high-confidence in their ability to make appropriate PEG placement decisions. Ethical and patient quality of life issues were given less importance as compared to purely clinical indications for approaching decision-making. On exploratory analysis, vascular neurologists reported high confidence compared to other specialties (31/33(94%) vs 18/30(62%); absolute difference(AD) of 32 percentage points(pp) (95% CI, 12.8-51.2)) and clinicians with less frequent follow-up were more likely to prefer earlier PEG placement (26/31(84%) vs 19/31(61%); AD 22.8 pp (95%CI, 1.33-44.2))

CONCLUSION

Clinicians report high confidence in making decisions about PEG-placement after stroke despite inconsistent guideline adherence, with a tendency to overestimate benefits of PEG-feeding. Structured goals-of-care conversations and individualized risk-benefit assessment incorporating procedural risks and prognosis for clinical recovery are needed.