City Research Online

Abstract

Introduction
Parental decision making regarding children's need for a gastrostomy is described as one of 'decisional conflict' (Mahant et al. Pediatrics 2011; 127(6):1471-148). Studies investigating parents' experiences have made various recommendations to improve healthcare professionals' (HCPs) practice. There are few studies investigating HCPs' views and practice.

Participants and Methods
Interviews were conducted with 10 community HCPs from 3 professions: dietician (2), specialist school nurse (3) and speech and language therapist (5), between June-July 2013. Interviewees were part of a multidisciplinary team supporting children with neurodisability. Interviews were audio-recorded, transcribed and analysed using content and thematic analysis using Mahant et al.'s (2011) framework of 'decisional conflict' as an overarching guide.

Results
HCPs demonstrated good awareness and expectation of the 'decisional conflict' that arises for families. However they perceived the decision making process as one that inevitably leads to surgery, placing the child's physical health and wellbeing as paramount over parental values. They described gastrostomy risks as minimal in comparison to naso-gastric tube (NGT) feeding or maintaining 'unsafe' oral feeding regimens. HCPs find the role of supporting families challenging and experience strong responsibility for owning the assumed risk associated with oral or NGT feeding. HCPs adopt a range of strategies to support families to consent to a gastrostomy.

Conclusion
This sample of HCPs viewed gastrostomy positively and as inevitable for children with neurodisability. Formal guidance to support decision making is required to ensure consistency of practice including advice on how to support families.

Publication Type:	Article
Additional Information:	This is the peer reviewed version of the following article: Morgan, S. , Hurt, C. S. & Craig, G. (2014). Parental decision making and gastrostomy: Professional’s awareness of conflict and strategies for support. Poster Sessions. Developmental Medicine & Child Neurology, 56, p. 31. which has been published in final form at https://doi.org/10.1111/dmcn.12485. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Subjects:	H Social Sciences > HM Sociology H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments:	School of Health & Psychological Sciences > Language & Communication Science
SWORD Depositor:	Symplectic Administrator

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