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Clausen MK, Bogh SB, Schmidt-Petersen M, Morsø L. Assessing nourishment problems at a hospital: what can we learn from them? BMJ Open Qual 2024; 13:e002745. [PMID: 38816005 PMCID: PMC11138294 DOI: 10.1136/bmjoq-2024-002745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/19/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Patient safety is a high priority in the Danish health care system, including that hospital patients get the proper nutrition during their stay. A Nutrition Committee at Odense University Hospital is responsible for policy regarding nourishment at the hospital. If patients experience suboptimal treatment, i.e. improper nourishment, in the Danish health care system, they have the right to file a complaint. These complaints enable the improvement potentials based on the patients' first hand experiences. Therefore, our aim was to examine the nutrition complaint pattern and to get a deeper understanding of the context surrounding nutrition problems, allowing the extraction of learning potentials. METHODS We analysed complaints submitted to Odense University Hospital between 2018 and 2022 using the Healthcare Complaint Analysis Tool. The complaints were categorised into categories, levels of severity and overall patient harm. The complaints containing a high-severity nutrition problem were read through and thematised into aspects not defined in the Healthcare Complaint Analysis Tool. RESULTS Between 2018 and 2022, 60 complaint cases containing 89 nutrition problems were filed to Odense University Hospital. Most (58.3%) of these were filed by the patients' relatives. The nutrition problems were mostly of low severity (56.2%), while 23.6% were severe, and 20.2% were very severe. The reading of 18 very severe nutrition complaints revealed a cascade of problems triggered by the nutrition problem in six cases. Moreover, we saw that two high-severity nutrition problems led to catastrophic harm. DISCUSSION A low proportion of nutrition problems may express an underestimation regarding nourishment at the hospital. A patient's threshold may not be exceeded by suboptimal nutrition and therefore does not file a complaint. However, complaints contain important insights contributing to wider learning, given that improvements at the hospital so far are based on clinicians' reporting, overlooking the patient perspective.
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Affiliation(s)
- Mette Kring Clausen
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Søren Bie Bogh
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Lars Morsø
- Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
- OPEN Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Blake CL, Brown TE, Pelecanos A, Moroney LB, Helios J, Hughes BGM, Chua B, Kenny LM. Enteral nutrition support and treatment toxicities in patients with head and neck cancer receiving definitive or adjuvant helical intensity-modulated radiotherapy with concurrent chemotherapy. Head Neck 2023; 45:417-430. [PMID: 36433667 DOI: 10.1002/hed.27249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 09/10/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Enteral nutrition (EN) is often required in patients with head and neck cancer (HNSCC); however, initiation criteria is limited or inconsistent. This study aimed to describe the relationship of treatment toxicities and requirement for EN and investigate toxicity and baseline characteristics association with EN duration. METHODS Acute toxicities and baseline characteristics were collected from patients with HNSCC (n = 110) undergoing H-IMRT. Percentage EN contributing to estimated requirements and EN duration were measured. RESULTS The threshold for patients needing ≥50% of estimated requirements via EN increased from week 3 to 4 for grade ≥2 oral/pharyngeal mucositis, dysgeusia, thick saliva and nausea, and for grade 3 dysphagia. Patients with grade 2-3 dysphagia had a reduced risk of ceasing EN compared to those with grade 0-1 dysphagia. CONCLUSIONS Using acute toxicities in clinical practice may be a useful tool to inform prompt initiation of EN prior to decline in nutritional status and anticipate EN duration.
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Affiliation(s)
- Claire L Blake
- Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Teresa E Brown
- Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Anita Pelecanos
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Laura B Moroney
- Department of Speech Pathology and Audiology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Jennifer Helios
- Department of Speech Pathology and Audiology, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin Chua
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lizbeth M Kenny
- Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Family Caregivers' Experiences of Caring for Patients With Head and Neck Cancer: A Systematic Review and Metasynthesis of Qualitative Studies. Cancer Nurs 2023; 46:E41-E61. [PMID: 35439200 PMCID: PMC9722382 DOI: 10.1097/ncc.0000000000001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Family caregivers of head and neck cancer (HNC) patients undertook heavy care tasks and role responsibilities. They were facing multiple challenges during the patients' cancer trajectory. OBJECTIVE The aim of this study was to synthesize existing qualitative evidence regarding family caregivers' experiences of caring for HNC patients. METHODS A meta-aggregation approach was used. Articles were collected from MEDLINE, EMBASE, CINAHL, Web of Science, PsycINFO, and Cochrane Library. Supplementary resources were collected by scrutinizing reference lists and performing citation tracking. RESULTS A total of 20 studies were included and synthesized. Three meta-themes covering "accepting the diagnosis and treatment on patients: a distressing process," "facing changes of life and adapting to new roles," and "appreciating the external supports" were identified with 10 subthemes. There was high confidence in the evidence for "facing changes of life and adapting to new roles" and moderate confidence in the evidence for the other 2 meta-themes. CONCLUSIONS Taking care of HNC patients is a distressing process. Caregivers took on role responsibilities and developed strategies to make adjustments to life changes, so as to provide better care for patients. External supports regarding caregiving and self-care were desired. IMPLICATIONS FOR PRACTICE Psychological distress was common among caregivers and calls for routine clinical screening. Providing caregivers with practical strategies to deal with daily caregiving tasks was crucial. Healthcare workers can play a critical role in providing tailored support in different caregiving stages. The findings informed the interventions and future research to improve HNC caregivers' experiences.
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Nutritional management of cancer patients in clinical practice in Spain: patients' and multidisciplinary health care professionals' perceptions. Eur J Clin Nutr 2022; 77:454-459. [PMID: 36550218 DOI: 10.1038/s41430-022-01251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is a prevalent problem in patients with cancer and is associated with poor prognosis. The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends the provision of nutritional support and evaluation. This study aims to describe the nutritional management of patients with cancer, including assessment of adherence, from the perspective of both patients and healthcare professionals (HCPs). SUBJECTS/METHODS A cross-sectional descriptive observational study was carried out through two surveys addressed to patients and HCPs. RESULTS A total of 230 cancer patients and 461 HCPs completed the questionnaire. The survey found 55.0% of patients experienced eating problems during treatment and 64.0% reported sequelae affecting nourishment. However, 60.1% of patients and 42.6% of HCPs indicated that nutritional status is not generally assessed. While 86.6% of HCPs stated that nutritional information is provided to patients, only 33.5% of patients reported having received it. Regarding nutritional adherence, 87.4% of HCPs stated that it is assessed whereas only 49.2% of patients receiving nutritional supplements confirmed this. General discomfort or gastrointestinal problems were the main issues hampering correct adherence perceived by both patients (41.8%) and HCPs (95.4%). CONCLUSIONS Our study demonstrate that different perceptions exist between patients and HCPs about nutritional management in cancer and suggests that in Spain nutritional approach is suboptimal in terms of screening/assessment of malnutrition, nutritional information provided to the patient, nutritional intervention and assessment of adherence to nutritional support. Therefore, measure should be taken to foster the adoption of ESPEN recommendations in clinical practice and to promote nutritional education of HCPs.
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Fiddimore E, Harrop E, Nelson A, Sivell S. "I don't want to hear statistics, I want real life stories": Systematic review and thematic synthesis of patient and caregiver experiences of Proton Beam Therapy. J Psychosoc Oncol 2022; 41:434-456. [PMID: 37155324 DOI: 10.1080/07347332.2022.2136997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PROBLEM IDENTIFICATION Proton Beam Therapy (PBT) is an advanced form of radiotherapy, yet little evidence exists on patient experience to inform decision making and improve future care. We thematically synthesized the qualitative evidence of patient and caregivers' perceptions and experiences of PBT. LITERATURE SEARCH Five electronic databases were systematically searched, using Medical Subject Headings (MeSH) terms and keywords. Two reviewers independently screened search results for qualitative studies relating to patients' and caregivers' experiences of PBT. The search generated 4,020 records, of which nine were eligible. Study quality (assessed by CASP checklist) varied. DATA SYNTHESIS Qualitative results were analyzed using thematic synthesis. Three main themes were generated: decision making and perceptions, living in the PBT "bubble," and coping with the cancer treatment journey. CONCLUSIONS PBT is not yet widely accessible worldwide, which uniquely influences the patient experience. Our review uncovers areas PBT providers could target to improve patient-centered care; however, additional primary qualitative research is recommended.
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Affiliation(s)
- Emma Fiddimore
- iBSc in Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Emily Harrop
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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"It's part of our life now": a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer. Support Care Cancer 2022; 30:10159-10167. [PMID: 36307655 PMCID: PMC9615617 DOI: 10.1007/s00520-022-07427-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/20/2022] [Indexed: 11/24/2022]
Abstract
Purpose Family members (FMs) of patients with head and neck cancer (HNC) report a change in their social eating experience. They miss out on the opportunities and benefits that eating with others provides. However, few studies investigate FM’s social eating experiences, with existing research primarily focusing on the patient experience. Therefore, the aim of this study was to explore the social eating experiences of FMs of patients who have had treatment for HNC. Methods A qualitative research design using semi-structured interviews was used to understand FM’s social eating experiences. Key themes were inductively developed from the data using reflexive thematic analysis. Results Twelve interviews were conducted with FMs, and three key themes were identified: (1) changes and challenges experienced by FMs due to HNC patients’ social eating difficulties, (2) living with social eating changes is a balancing act, and (3) FMs’ efforts to promote social eating for a patient with HNC. FMs expressed significant changes to their social eating habits within and outside the home, indicating the need for support to meet their own emotional, psychological and social needs. Conclusion FMs experience many demands and tensions, having to balance the psychological impact they experience, which are often minimised, whilst attempting to find the best ways to support, protect and encourage their loved ones to adjust and adapt to social eating changes. Therefore, interventions need to support FMs’ challenges and equip them to know how to best support patients living with HNC and themselves.
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Edwards A, Brown T, Hughes BGM, Bauer J. The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review. Support Care Cancer 2022; 30:7191-7204. [PMID: 35477809 PMCID: PMC9385807 DOI: 10.1007/s00520-022-07056-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/11/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Human papillomavirus (HPV) is now the primary cause of oropharyngeal head and neck cancer (OPC) worldwide; yet limited research has examined the effect of HPV-positive status (OPC+) on nutrition outcomes. This study aims to determine the impact of HPV status on nutritional outcomes for adult patients with OPC undergoing any treatment modality. METHODS A systematic literature review was conducted up to and including July 2021 of PubMed, Embase, CENTRAL, CINAHL, and Web of Science to identify studies conducted in adults (>18 years) with known OPC reporting on any outcome(s) related to nutrition, according to HPV status (OPC+ versus OPC-). Bias was assessed using QUIPS tool, with certainty of evidence assessed using GRADE system. RESULTS Six studies (total n = 635) all at moderate-high risk of bias were included. Three studies reported on weight change (n = 255), three feeding tube dependency (n = 380), three feeding tube timing of placement (prophylactic or reactive) and/or utilisation (n = 255), two nutritional (energy and/or protein) intake (n = 230), and one nutritional status (n = 83). Patients with OPC+ may experience greater weight loss, may have higher utilisation of reactive feeding tubes (both GRADE low certainty, downgraded due to serious bias and imprecision), and may have lower feeding tube dependency rates (GRADE low certainty, downgraded due to serious bias and inconsistency) versus OPC- . It is uncertain whether nutritional intake and nutritional status differed between populations (GRADE very low certainty, downgraded due to serious bias and very serious imprecision). CONCLUSION Further, high-quality research is needed to understand optimal nutritional care practices for patients with OPC + to achieve positive health outcomes into survivorship.
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Affiliation(s)
- Anna Edwards
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia.
- Nutrition & Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, QLD, Australia.
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia.
| | - Teresa Brown
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Brett G M Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Judy Bauer
- School of Human Movements and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
- Nutrition, Dietetics & Food, School of Clinical Sciences, Monash Health, Monash University, Victoria, Australia
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8
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Wang P, Zheng X, Luo Z, Wang Y, Guo Z, Zhou Y. Perceptions and experiences of nutritional management needs for patients with esophageal cancer during the peri-radiotherapy period: A qualitative study. Asia Pac J Oncol Nurs 2022; 9:202-209. [PMID: 35571626 PMCID: PMC9096731 DOI: 10.1016/j.apjon.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/09/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Malnutrition in patients with esophageal cancer is a major health problem. However, the information about the perceptions and experiences of nutritional management needs during the peri-radiotherapy period is lacking. This study aimed to understand the experiences of, and perspectives on, nutritional management needs of patients with esophageal cancer, family caregivers, doctors, and nurses so as to explore the influencing factors and coping strategies to meet nutritional management needs for patients with esophageal cancer during the peri-radiotherapy period. METHODS A qualitative study with purposive and theoretical sampling was used in this study. One-to-one and focus group interviews were held among patients, main family caregivers, doctors, and nurses in a tertiary general hospital and a tertiary cancer hospital in Shantou, south of China, from August to September in 2020. Data were analyzed using grounded theory by a three-level coding method. The reporting of this study adhered to the COREQ guidelines. RESULTS A total of 12 patients, 10 main family caregivers, 6 doctors, and 9 nurses were interviewed. According to the participants, the three main categories, "personal cognition," "family and social factors," and "nutritional management environment and system," were the main factors influencing nutritional management needs. "Lack of nutrition-related cognition," "effects of feeding-related symptom clusters," and "motivation" were the three major factors that constituted participants' personal cognition on nutritional management. "Dietary conditions in medical institutions," "nutritional management system in medical institutions," and "home nutritional care" were the main components of the nutritional management environment and system. The coping strategies included standardized nutritional training for staff, patients and caregivers, social support system, discharge preparation services, multidisciplinary nutritional management, and construction of the organization and management system. CONCLUSIONS Malnutrition in patients with esophageal cancer who suffer from great diet pain during the peri-radiotherapy period has become a concerning health issue. It is still challenging and needs more nutritional research. The full identification of influencing factors for nutritional management needs and the proposal of coping strategies may help provide theoretical support and a practical basis for constructing a tumor nutritional management scheme to meet the needs of patients with esophageal cancer.
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Affiliation(s)
- Peiru Wang
- Department of Nursing, Shantou Central Hospital, Shantou, China
| | - Xiang Zheng
- Department of Radiotherapy, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Zebing Luo
- Shantou University Medical College, Shantou, China
| | - Yiru Wang
- Department of Nursing, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Zhijun Guo
- Department of Nursing, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Yuhua Zhou
- Department of Nursing, Shantou Central Hospital, Shantou, China
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Weaver R, O'Connor M, Golding RM, Gibson C, White R, Jackson M, Langbecker D, Bosco AM, Tan M, Halkett GKB. "My life's not my own": A qualitative study into the expectations of head and neck cancer carers. Support Care Cancer 2022; 30:4073-4080. [PMID: 35066666 DOI: 10.1007/s00520-021-06761-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Cancers that originate from the upper aerodigestive tract are collectively known as head and neck cancer. The most common are squamous cell carcinomas of the oropharynx, larynx, and oral cavity. Head and neck cancer patients experience significant physical and psychological changes because of the disease and treatment. There is a substantial strain on family carers who have extensive responsibilities over most aspects of the patient's life. The aim of the study was to understand the perspectives of being an HNC carer and their perceived expectations of the role. METHODS The study adopted a qualitative research design with a social constructionist epistemology. Interviews were conducted with 20 carers who were currently caring for someone diagnosed with head and neck cancer. RESULTS Three overarching themes were identified: taking responsibility for the patient's nutrition, navigating a new and different relationship, and "my life's not my own." Participants felt responsible for ensuring the patient was eating and became increasingly frustrated when the patient was unable to intake food. Carers prioritised the patients' needs at the expense of their own, and several came to resent the role. CONCLUSION Carers' expectations of their role informed how they approached giving care. Carers need to be supported from diagnosis and encouraged to prioritise their own wellbeing.
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Affiliation(s)
- Rhys Weaver
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Moira O'Connor
- WA Cancer Prevention Research Unit, School of Population Health, Discipline of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia
| | - Raelee M Golding
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Chandrika Gibson
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Melanie Jackson
- GenesisCare Perth Radiation Oncology, Wembley, WA, Australia
| | - Danette Langbecker
- Centre for Online Health, The University of Queensland, St Lucia, Australia
| | - Anna Maria Bosco
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Maureen Tan
- WA Cancer Prevention Research Unit, School of Population Health, Discipline of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, 6845, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Blake C, Edwards A, Treleaven E, Brown T, Hughes B, Lin C, Kenny L, Banks M, Bauer J. Evaluation of a novel pre-treatment model of nutrition care for patients with head and neck cancer receiving chemoradiotherapy. Nutr Diet 2021; 79:206-216. [PMID: 34854199 DOI: 10.1111/1747-0080.12714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022]
Abstract
AIMS Weight loss and malnutrition occur frequently in patients with head and neck cancer and are associated with reduced survival. This pragmatic study aimed to determine the effect of a novel pre-treatment model of nutrition care on nutrition outcomes for patients with head and neck cancer receiving chemoradiotherapy. METHODS This health service evaluation consisted of an evaluation of the new model of care implementation (Phase 1) and an evaluation of patient outcomes (Phase 2) in pre- and post-implementation cohorts (n = 64 and n = 47, respectively). All Phase 2 patients received a prophylactic gastrostomy. The new model of care consisted of dietary counselling and commencement of proactive supplementary enteral nutrition via a prophylactic gastrostomy, in addition to normal oral intake, prior to treatment commencement. Nutrition outcomes were collected at baseline (pre-treatment) and 3 months post-radiotherapy completion. RESULTS The new model of care was successfully incorporated into practice with high referral (96.5%) and attendance (91.5%) rates to the counselling session, and high adherence rates to proactive tube feeding (80.9%). Patients in the post-implementation cohort had less weight-loss (1.2%; p = 0.338) and saw less of a decline in nutritional status compared to patients in the pre-implementation cohort (23% vs. 30%, respectively; p = 0.572), deemed clinically important. However, patients still experienced critical weight loss overall (mean 9.9%). CONCLUSION Pre-treatment nutrition care was feasible in standard clinical practice and demonstrated clinically relevant outcome improvements for patients. Future high-quality research is warranted to investigate further multidisciplinary strategies to attenuate weight-loss further, inclusive of patient-reported barriers and enablers to nutrition interventions.
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Affiliation(s)
- Claire Blake
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Anna Edwards
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.,Nutrition & Dietetics, Toowoomba Hospital, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Elise Treleaven
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Teresa Brown
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Brett Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Charles Lin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Lizbeth Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Merrilyn Banks
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Judy Bauer
- Nutrition & Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Queensland, Australia.,The School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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Hiatt JS, Young A, Brown TE, Banks M, Bauer J. Patient and carer experience of nutrition care throughout and beyond treatment for head and neck cancer: a qualitative longitudinal study. Support Care Cancer 2021; 30:813-824. [PMID: 34390400 DOI: 10.1007/s00520-021-06484-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
Nutrition care plays a critical role in optimising outcomes for patients receiving treatment for head and neck cancer (HNC), with carers playing an important role in supporting patients to maintain nutrition intake. This study explores patient and carer experience of nutrition care from diagnosis of HNC to 1 year post treatment completion to identify areas for improvement of service delivery. A longitudinal qualitative study design was used with a heterogeneous sample of 20 patients and 15 carers of patients undergoing curative intent treatment for HNC. Interviews conducted at four time points provided a total of 117 interview datasets that were analysed using reflexive thematic analysis based on Gadamerian hermeneutic inquiry. Patient and carer experiences were reflected in two primary themes: (1) the battle to maintain control and (2) navigating the road ahead. This research identifies the need to co-design strategies to improve nutrition care that is inclusive of patients and carers.
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Affiliation(s)
- Joanne S Hiatt
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia. .,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia.
| | - Adrienne Young
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Teresa E Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Merrilyn Banks
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Butterfield Street, Herston, QLD, 4029, Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Australia
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12
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Patient and carer experiences of nutrition in cancer care: a mixed-methods study. Support Care Cancer 2021; 29:5475-5485. [PMID: 33710413 DOI: 10.1007/s00520-021-06111-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/24/2021] [Indexed: 01/06/2023]
Abstract
PURPOSE Evidence-based guidelines exist to guide health professionals and services about cancer nutrition care; however, the views of cancer patients and carers are not well understood. This study aimed to understand the experience and needs of cancer patients and carers regarding nutrition care across the care continuum. METHODS Using a mixed-methods approach, cancer patients and carers completed a cross-sectional online survey and focus groups. Participants were recruited through health services and cancer organisation consumer networks via email distribution lists, e-newsletters, and social media. Focus groups were audio-recorded, transcribed, and analysed using content analysis. RESULTS Of 165 survey respondents, only 51% (n=84) reported they talked to a health professional about their nutrition care at any time-point, and only 32% with a dietitian. The majority (84%) of patients and carers felt nutrition was important at one or more time-points in their cancer path, indicating during and after cancer treatment the most important. However, perceived support from health professionals for nutrition care was deemed low at all time-points. Five focus groups were held (n=20; 16 patients, 2 carers, 2 both patients/carers) and five themes emerged: nutrition information, experiences and need; control over diet and nutrition; importance and value of nutrition; access to support; what optimal nutrition care looks like. CONCLUSION Patients and carers felt nutrition was important during their cancer path, but perceived support from health professionals for nutrition care was low. This study has highlighted patient and carer nutrition experiences that will inform development of a co-designed optimal cancer nutrition care pathway.
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