Representations and practices of physicians about gastrostomy after 70 years old: Qualitative research

Objectives. - Gastrostomy is a method of reference in the renutrition of malnourished elderly people. However, only few physicians use an enteral nutrition. The aim of this study was to analyze the representations and practices of physicians about gastrostomy in patients above 70 years-old, and to identify difficulties encountered in decision making in geriatrics. Materials ans methods. - This study was a qualitative research based on individual, semi-directed interviews. Results. - Ten physicians, geriatrics and palliative care, were interviewed. Their theoretical knowledge followed French and European recommendations in terms of indication, contra-indication and surveillance of risk factors for gastrostomy. Physicians had a pejorative representation of gastrostomy. It depended on the representation of the "food", which is specific, according to the personality, the design of care and sociocultural references. Difficulties encountered by physicians in decision-making were related to lack of training, lack of experience and influence of individual representations. Decision-making required a global and personalized evaluation of each patient. To make a decision, physician considered the patient's opinion first. Conclusion. - Awareness of one's own representations can improve support. Methods to improve geriatric practice about gastrostomy are: training physicians, analysis of complex cases, formalizing multidisciplinary meetings and conducting collegiality ethical reflections. (C) 2018 Association pour le developpement de la recherche en nutrition (ADREN). Published by Elsevier Masson SAS. All rights reserved.