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Race and prevalence of percutaneous endoscopic gastrostomy tubes in patients with advanced dementia

Published online by Cambridge University Press:  26 January 2022

David Henao Open the ORCID record for David Henao [Opens in a new window] ,
Chere Gregory ,
Gloria Walters ,
Charles Stinson  and
Yvonne Dixon
David Henao*
Affiliation:
Office of Diversity, Inclusion, and Equity, Novant Health, Winston-Salem, NC 27103
Chere Gregory
Affiliation:
Office of Diversity, Inclusion, and Equity, Novant Health, Winston-Salem, NC 27103
Gloria Walters
Affiliation:
Center for Professional Practice & Development, Novant Health, Winston-Salem, NC 27103
Charles Stinson
Affiliation:
Palliative Care, Novant Health, Winston-Salem, NC 27103
Yvonne Dixon
Affiliation:
Office of Diversity, Inclusion, and Equity, Novant Health, Winston-Salem, NC 27103
*
Author for correspondence: David Henao, Office of Diversity, Inclusion, and Equity, Novant Health, 2000 Frontis Plaza, Suite 101, Winston-Salem, NC 27103, USA. E-mail: dhenao@novanthealth.org
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Abstract

Objective

Millions of Americans may face hard decisions when it comes to providing nutrition for their loved ones with advanced dementia. This study aimed to ascertain whether there is a difference in feeding tube placement between White and Black patients with advanced dementia and whether this potential difference varied by patient's other demographic and clinical characteristics.

Method

This is a retrospective, observational study conducted at Novant Health, a 15-hospital system in the southeastern United States. Data were obtained from Epic systems and included all hospital admissions with a diagnosis of advanced dementia, a total of 21,939, between July 1, 2015, and December 31, 2018. Descriptive statistics and logistics analyses were conducted to assess the relationship between receiving percutaneous endoscopic gastrostomy (PEG) and race, controlling for demographic and clinical characteristics.

Results

Among patients admitted with advanced dementia, the multivariable logistic regression, controlled for age, gender, LOS, palliative care, and vascular etiology showed that Blacks had higher odds of having PEG tubes inserted than White patients (OR 1.97; CI 1.51–2.55; P < 0.001). Patients with longer stays had higher odds of PEG tube insertion. Females had lower odds of PEG tube insertion than males. There was no statistical significance in PEG insertion based on age, etiology, and palliative care consult.

Significance of results

The reasons for the observed higher odds of receiving PEG tubes among Black patients than White patients are likely multifactorial and embedded in a different approach to end-of-life care conversations by providers and caregivers of Black and White patients. Providers may need to be more aware of potential unconscious biases when talking to caregivers, especially in race-discordant relationships, have courageous conversations with caregivers, and be more aware of the importance of keeping in mind families’ and caregivers’ culture, including spirituality, when making end-of-life decisions.

Keywords

Advanced dementiaDisparitiesGastrostomy tubesRace
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 2 , April 2023 , pp. 224 - 229
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Copyright
© Novant Health, 2022. Published by Cambridge University Press

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