**9. Conclusion**

Based on a review of current literature some important points have been raised around the recommendation process for enteral nutrition in adult patients with dysphagia. The key focus in any decision making process for medical procedures should be on patient autonomy. If a patient consents to placement of a PEG for the provision of long term enteral nutrition, with a full understanding of the impact it will have on them, not only medically but socially and emotionally too, then a standard assessment procedure needs to follow. Assessment should be carried out by a team of health care professionals, including the SLT, and should include a consideration of the patients underlying medical condition, indication for PEG, prognosis of survival post procedure, age, nutritional status, the presence of co-morbidities and biochemical parameters. Based on the assessment findings, the team, in conjunction with the patient and their family, need to make a recommendation. If a patient is considered to be a high risk for mortality following PEG placement then alternate methods of intake need to be discussed with and recommended to the patient and their family, with education and counselling provided on the benefits and risks of oral intake as a form of palliation. A thorough assessment procedure will help to ensure that futile procedures are avoided and only patients who consent to and who will benefit from PEG placement are recommended for the procedure.
