Abstract
Rationale: Increasingly, patients with advanced ovarian cancer in
bowel obstruction are receiving home parenteral nutrition (HPN). HPN
is contentious in this sitution as it may increase the burden on patients
with palliative needs and little is known about the decision making
process. The aim of this study was to explore how decisions for HPN are
taken and to investigate barriers and facilitators to implementation.
Methods: This was a qualitative study underpinned by phenomenology. Ninety-three longitudinal in-depth interviews were undertaken with 20 patients with advanced ovarian cancer in bowel obstruction receiving parenteral nutrition, their relatives and healthcare professionals over 14 months. Participants were interviewed a maximum of 4 months. Participants were interviewed a maximum of four times. Interview transcripts were analysed thematically guided by
the techniques of Van Manen.
Results: We found variance between oncologists and patients
regarding ownership of the decision for HPN. The oncologists believed
they were engaging in shared decision making, whereas patients felt
that the decision was driven by the oncologist. Nevertheless they were
content to have the treatment as they viewed the choice as HPN or
death.
The principal mutable barrier was difficulties in communication across
professional disciplines and organisations. Facilitators to a timely
discharge included developing single point of contact between
organisations, improving communication and implementing standardised clinical and operational processes.
Conclusions: Oncologists and patients differ in their perceptions of
how treatment decisions are made. Although patients are satisfied
with the process, it may be beneficial for healthcare professionals to
ratify patients’ understanding of treatment.
bowel obstruction are receiving home parenteral nutrition (HPN). HPN
is contentious in this sitution as it may increase the burden on patients
with palliative needs and little is known about the decision making
process. The aim of this study was to explore how decisions for HPN are
taken and to investigate barriers and facilitators to implementation.
Methods: This was a qualitative study underpinned by phenomenology. Ninety-three longitudinal in-depth interviews were undertaken with 20 patients with advanced ovarian cancer in bowel obstruction receiving parenteral nutrition, their relatives and healthcare professionals over 14 months. Participants were interviewed a maximum of 4 months. Participants were interviewed a maximum of four times. Interview transcripts were analysed thematically guided by
the techniques of Van Manen.
Results: We found variance between oncologists and patients
regarding ownership of the decision for HPN. The oncologists believed
they were engaging in shared decision making, whereas patients felt
that the decision was driven by the oncologist. Nevertheless they were
content to have the treatment as they viewed the choice as HPN or
death.
The principal mutable barrier was difficulties in communication across
professional disciplines and organisations. Facilitators to a timely
discharge included developing single point of contact between
organisations, improving communication and implementing standardised clinical and operational processes.
Conclusions: Oncologists and patients differ in their perceptions of
how treatment decisions are made. Although patients are satisfied
with the process, it may be beneficial for healthcare professionals to
ratify patients’ understanding of treatment.
| Original language | English |
|---|---|
| Title of host publication | Clinical Nutrition |
| Pages | s87-s88 |
| Volume | 38 |
| Publication status | Published - Sept 2019 |
