Abstract TMP80: Physician Preferences, Beliefs, and Practices on Post-Stroke Dysphagia Management

Abstract

Introduction: Dysphagia affects up to 2/3 of stroke patients; however, management practices are widely disparate. Despite lack of evidence for percutaneous endoscopic gastrostomy (PEG) placement, PEGs are placed in up to 23% of stroke patients a mean of 7 days from admission. We surveyed physicians who manage stroke patients in a large network of hospitals to evaluate knowledge and practices around dysphagia management. Methods: A 20 question survey was compiled and included questions regarding provider demographics, clinical experience and practice patterns for dysphagia management, knowledge about clinical variables associated with persistent dysphagia and beliefs about patient and system variables that influence decisions about dysphagia management (Table 1). Results: 171 providers of stroke care in the Memorial Hermann Healthcare System (13 hospitals) were surveyed and 52 (30%) participated (Table 1). Approximately, 67% of providers were extremely or very comfortable with management of post-stroke dysphagia. There was a trend toward an association between provider specialty and comfort, with critical care practitioners likely to feel more comfortable and internal medicine physicians less comfortable (p = 0.07). While 61% of providers recommend PEG placement within 3-7 days of admission, 77% of providers would delay PEG placement if they could. Providers aware of published trials showing poor outcomes after PEG were more likely to want more time (p=0.04). Providers reported that stroke location (86%), dysarthria severity (77%), and age (71%) of patients were most likely to be associated with persistent dysphagia. Conclusions: To our knowledge, this survey represents the first to assess provider practices, knowledge, and beliefs regarding PEG placement and dysphagia management. Most providers in our network would like more time to determine recovery of swallow function prior to placing PEG tubes, if length of stay and other factors were not issues.