|Title||Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Advanced Cancer: Patient Expectations and Decisional Regret (SA314A)|
|Publication Type||Journal Article|
|Year of Publication||2023|
|Authors||Goldberg, J, Sheppard, RS, Hoque, A, Patel, RV, Nelson, J|
|Journal||Journal of Pain and Symptom Management|
|Keywords||Cancer, decisional regret, patient expectations|
Outcomes: 1. Describe the potential benefits of decompressive percutaneous endoscopic gastrostomy (dPEG) in patients with a malignant bowel obstruction 2. Evaluate the importance of effective communication regarding dEPG in patients with advanced cancer Decompressive percutaneous endoscopic gastrostomy (dPEG) is often recommended for palliation of symptoms in patients with malignant bowel obstruction. While this intervention can help improve comfort, patients may have unrealistic expectations about their ability to resume eating, enhance nutritional status, build strength, and receive further disease-directed treatment. We undertook this study to evaluate patients’ expectations about the impact of dPEG placement. We prospectively enrolled 50 adult patients in our dedicated cancer hospital who were scheduled for dPEG for management of MBO between September 2019 to February 2022. Before the procedure, patients completed the FACT-G7, a closed-ended questionnaire about expected outcomes of the procedure, and a brief, semi-structured qualitative interview exploring their understanding of the procedure and expectations for the future. Two weeks after the procedure, patients were contacted to complete the FACT-G7 for a second time and Decision Regret Scale. Sociodemographic, clinical variables, and patient outcomes were collected. The most common primary tumors in this cohort were ovarian (28%), pancreatic (24%), and colon (14%), and the median time to death after dPEG was 30 days (range 5–780). Before the procedure, almost half of patients had unrealistic expectations about the potential benefits of dPEG on their ability to eat and to prolong their life and cited these expected benefits as important in their decision to undergo the procedure. At follow-up, one-third of patients expressed regret about the decision. However, patients reported improvement in symptom burden after the procedure compared to before. Our findings suggest ongoing needs to improve communication to help align patients’ expectations with their future experience and support them to manage challenges.