Impact of percutaneous endoscopic gastrostomies on patient mortality following a best interest decision

Background: Percutaneous endoscopic gastrostomies (PEGs) provide nutrition for swallowing-impaired patients. However, the procedure carries risks and requires best-interest decisions to be made when patients cannot consent. Aims: A systematised literature search was undertaken to explore the current knowledge on whether making a best interest decision for PEGs affects the mortality outcome of patients, when compared to patients that have consented. Methods: The search was conducted across four databases. The search identified 178 articles, of which 107 were screened and 43 fully reviewed. Studies were appraised using various tools to identify themes. Results: Four themes were identified: mortality rates, complexity of decisions, unknown prognosis, and patients cannot voice own opinions. Discussion: This study explored the impact of best interest decisions on PEG mortality outcomes, identifying key themes including mortality, decision complexity, prognosis uncertainty, and patient incapacity to voice opinions. Implications for practice: Nurses should be aware of the complexity surrounding best interest decisions as they relate to PEG procedures. Conclusions: Best interest decisions for PEG insertion are complex and limited research exists on how challenges affect mortality outcomes. Further research is needed.