Perspectivas clínicas, bioéticas y psicosociales en la toma de decisiones para la gastrostomía endoscópica percutánea en personas con enfermedades neurodegenerativas

Abstract

Background and objective

Dysphagia in individuals with neurodegenerative diseases presents clinical and ethical challenges when deciding whether to implement percutaneous endoscopic gastrostomy (PEG). Speech-language pathologists (SLPs) play a crucial role in this process, assessing not only the severity of dysphagia and the underlying pathology but also bioethical and psychosocial factors. Previous studies have indicated that this decision is not based solely on clinical criteria but integrates multiple dimensions. This study aims to explore the clinical, bioethical, and psychosocial perceptions of SLPs regarding decision-making in the indication of PEG in individuals with neurodegenerative diseases.

Patients or materials and methods

A qualitative study was conducted using semi-structured interviews with 10 SLPs experienced in managing dysphagia in neurodegenerative diseases. Content analysis was applied to identify emerging patterns in decision-making, categorizing findings into five key dimensions: diagnostic and prognostic considerations, clinical swallowing assessment, social and healthcare context, decision-making process, and the role of the SLP in the indication of PEG.

Results

Decision-making regarding PEG is not solely dependent on clinical assessment but also considers the individual's autonomy, advance directives, perceived quality of life, and socio-family context. Ethical dilemmas related to disease progression and family involvement were identified. Additionally, SLPs emphasized the need for greater training in bioethics and communication to effectively address these challenges.

Conclusions

This study highlights the importance of an interdisciplinary approach to PEG indication, balancing clinical, ethical, and psychosocial factors. Strengthening training in bioethics and communication, along with the development of policies that ensure equitable access to specialized resources, is recommended.