Limited PEG tube use: the experience of long-term care directions

To describe long-term care nursing directors' experiences with percutaneous endoscopic gastrostomy to understand the limited use of it in Taiwanese long-term care facilities.

Percutaneous endoscopic gastrostomy tubes, used in Western countries since 1980, have not been readily used in Taiwanese long-term care facilities since their introduction in 1995. Instead, nasogastric tubes are used for extended periods. The reasons for limited percutaneous endoscopic gastrostomy use among long-term care residents are unknown.

A phenomenologic qualitative design using in-depth semi-structured interviews collected the percutaneous endoscopic gastrostomy use experiences of directors of long-term care facilities. The directors also provided descriptive data on the prevalence of feeding tubes among their residents.

Eight directors of long-term care facilities in southern Taiwan participated in tape-recorded interviews. Data were thematically analysed using the methods of Strauss and Corbin. Feeding tube prevalence data were analysed using descriptive statistics.

Four themes emerged as contributing to limited percutaneous endoscopic gastrostomy use in long-term care facilities: acceptability, availability, affordability and accountability. Over one-third of the residents required feeding tubes with 97% of those having nasogastric tube. Nasogastric tubes were used for a year or more in over half of the patients requiring enteral feeding.

Chinese cultural values play a significant role in influencing end-of-life care and decisions about percutaneous endoscopic gastrostomy use. Nursing directors in long-term care assume a gatekeeper role to promote acceptability, provide availability and ensure accountability of nutritional interventions. Policy makers must be engaged to promote the affordability of percutaneous endoscopic gastrostomy use among long-term care residents.

To improve nutritional outcomes among long-term care residents, nurses must acknowledge the Chinese culture related to percutaneous endoscopic gastrostomy tubes. Professionals must provide sufficient information about the advantages of percutaneous endoscopic gastrostomy tubes and discuss with families the meaning of quality of life and suffering at the end-of-life.