Influence of patient and physician characteristics on percutaneous endoscopic gastrostomy tube decision-making

Data are lacking to support percutaneous endoscopic gastrostomy (PEG) tube placement in advanced dementia, yet it is common, especially in the southeast United States and in African Americans. In a cross-sectional survey, we examine whether physicians recommend PEG placement more for African American than Caucasian patients and identify physician characteristics related to recommendation for PEG.

We randomly assigned two versions, varying only by race, of a case patient with advanced dementia to all internal and family medicine physicians in the North Carolina Medical Society. Respondents gave recommendations regarding PEG tube feeding and demographic data including their race, age, gender, and specialty. We analyzed data using logistic regression, controlling for physician characteristics that were statistically significant in chi(2) analyses.

Of 2058 physicians, 53% (n = 1,083) responded. Of 981 responses with complete data, 18.0% recommended PEG, 80.0% recommended against PEG or made no recommendation. Recommendations for PEG did not differ significantly by race of the case patient (Caucasian = 16.4% versus African American = 19.6%). Fewer recommendations for PEG tube placement were made by Caucasian (13.0% versus Asian 54.3% and African American 40.0%; p < 0.001) and internal medicine and geriatrics physicians (13.8% and 9.1% versus family medicine 23.4%; p = 0.001). Of African American physicians, 51.4% recommended PEG for African American patients and 24.0% for the Caucasian patient.

In this survey, recommendation for PEG tube feeding differed significantly by physician race and specialty, and not by race of the case patient. Additional research is needed to measure whether real-life treatment recommendations vary by physician race, physician-patient race concordance and physician specialty.