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Checklin M, O'Halloran R, Foster AM, Hutchison A, Wilson T, Bowen A, Vat L, Lawson N, Lenne P, Packer RL. The health care experiences of people with head and neck cancer: A scoping review. Head Neck 2024; 46:74-85. [PMID: 37882242 DOI: 10.1002/hed.27558] [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: 09/07/2022] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. METHOD Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. RESULTS Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. CONCLUSION Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.
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Affiliation(s)
- Martin Checklin
- Epworth Healthcare, Richmond, Victoria, Australia
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Abby M Foster
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery & Rehabilitation, Melbourne, Victoria, Australia
| | - Alana Hutchison
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Alanna Bowen
- Alanna Bowen Speech Pathology, Melbourne, Victoria, Australia
| | - Laura Vat
- Epworth Healthcare, Richmond, Victoria, Australia
| | | | | | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Loke SXY, Chew EYH, Siew AL, Glass GF, Chan EY. Transiting Back Home: Caregivers' Lived Experiences in Caring for Loved Ones on the Nasogastric Tube in the Home-Setting in Singapore. J Transcult Nurs 2023; 34:343-355. [PMID: 37226459 DOI: 10.1177/10436596231175163] [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] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Little is understood about caregivers' lived experiences when first caring for patients on the nasogastric tube at home in an Asian setting. To enhance understanding, our study aimed to chart these caregivers' psycho-emotional evolutions felt during such caregiving experiences in Singapore. METHOD Utilizing purposive sampling, a descriptive phenomenological study was performed, with semi-structured interviews of 10 caregivers of persons on nasogastric tube feeding conducted. Thematic analysis was utilized. RESULTS Our findings chart four psycho-emotional transitions of a caregiver's journey in nasogastric tube feeding and the cultural dynamics involved-(a) Disruption of Caregivers' Normality: Attempting to Grasp Reality, (b) Encountering Road-Blocks: Despondency Arises and Frustrations Abound, (c) Adjusting to the New Normal: Reclaiming Confidence and Positivity, (d) Thriving and Integrating into the New Normal, and (e) Cultural Dynamics At Play. DISCUSSION Our findings illuminate the understanding of caregivers' varying needs, guiding delivery of culturally-congruent caregiver support targeted at each psycho-emotional evolution.
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Affiliation(s)
| | | | | | | | - Ee Yuee Chan
- Tan Tock Seng Hospital, Singapore
- Geriatric Education and Research Institute, Singapore
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3
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Zhang Y, Ma C, Li C, Chen Q, Shen M, Wang Y. Clinician's attitude to enteral nutrition with percutaneous endoscopic gastrostomy: a survey in China. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:42. [PMID: 34565469 PMCID: PMC8474729 DOI: 10.1186/s41043-021-00264-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/07/2021] [Indexed: 04/19/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is recommended for long-term enteral nutrition. However, long-term nasogastric (NGT) feeding is still commonplace in China. We surveyed Chinese clinicians' opinions toward PEG feeding in order to identify the potential barriers to acceptancy of PEG feeding. METHODS A self-reported questionnaire was developed and distributed to 600 doctors. Five-point Likert scales were used for most responses. RESULTS Of 525 respondents, the mainly nutritional support method was NGT while PEG was less used. Doctors working in the tertiary class A hospitals and radiotherapy department were more likely to choose PEG feeding (p = 0.000). Overall, 241 (46%) participants did not know PEG and 284 (54%) have different understanding degree of PEG. Age (p = 0.002), working life (p = 0.044) and professionalism (p = 0.005) were significantly related to the understanding of PEG. Levels of agreement was high (score of 3.47) for using PEG in patients with prolonged stroke-associated dysphagia. There was high agreement level in the statement that PEG was unnecessary when NGT could sustain the basic needs of patients, though better outcome can be predicted with PEG feeding. The highest scoring factor (score of 3.91) that influenced clinicians' choice of PEG was resistance from patients and families and the second one was the poor cooperation among departments (score of 3.80). CONCLUSIONS Doctors' insufficient knowledge of PEG feeding, resistance from patients and families, poor cooperation among departments, all these factors leading physicians to prefer more conservative treatment to avoid disputes rather than better ones.
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Affiliation(s)
- Yijie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
- School of Nursing, Medical College of Soochow University, No.188 Shizi St, Suzhou, China
| | - Chen Ma
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Chenxi Li
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Qian Chen
- School of Nursing, Medical College of Soochow University, No.188 Shizi St, Suzhou, China
| | - Meifen Shen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
| | - Yuyu Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, China
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4
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Yeung CW, Gilbertson-White S, Wickersham KE. "Live your life cuz everybody's terminal": Describing emotions and coping behaviors of rural advanced cancer patients. J Rural Health 2021; 38:63-69. [PMID: 33856695 DOI: 10.1111/jrh.12576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Culturally competent health care has led to increasing interest in how patients' identities influence the management of their health. The ways rural patients with advanced cancer process emotions and cope with their disease may be influenced by their rural context. The aims for this study were to (1) describe the emotions rural cancer patients experience, (2) describe how rural cancer patients manage their emotions within their rural context, and (3) interlace the themes related to coping with emotions. METHODS This paper is a subanalysis of a larger project focused on symptom management among rural patients living with advanced cancer. Using a qualitative descriptive design, authors read and coded patient interview transcripts to extract key perspectives related to managing emotions within a rural context. FINDINGS Sixteen participants, 10 men and 6 women, with a mean age of 68.75 years completed this study. Participants described a spectrum of emotional experiences. Some participants reported no distress, and some described high levels of distress. While previous writers described low levels of religious coping among rural patients, participants in this study often named their faith/spirituality as a major source of emotional coping. Participants also galvanized their social support network, particularly those in their religious community. Finally, participants in this study reported the use of medication as a last resort. CONCLUSION Results from this study might be influenced from cultural variables found in the rural community; specifically, religiosity and close social networks. Future interventions need to be tailored to the unique responses of rural patients.
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Affiliation(s)
- Chi W Yeung
- VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Karen E Wickersham
- University of South Carolina College of Nursing, Columbia, South Carolina, USA
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6
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Patient and carer experience of nutrition care throughout treatment for head and neck cancer: a systematic qualitative review and thematic synthesis. Support Care Cancer 2020; 28:5633-5647. [PMID: 32642952 DOI: 10.1007/s00520-020-05576-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/11/2020] [Indexed: 02/07/2023]
Abstract
Nutrition care plays a critical role in the provision of best practice care to head and neck cancer (HNC) patients, with carers playing an important role in supporting patients to maintain nutrition intake. This qualitative systematic review investigated patient and carer experience of nutrition care throughout and beyond HNC treatment. Five databases were systematically searched for qualitative studies reporting on patient and carer experience of nutrition care throughout HNC. Twenty-five studies including 435 patients and 46 carers were identified, revealing three themes: information and support in the healthcare setting, enteral feeding challenges and management, and life outside hospital. Findings highlight the importance of providing individualised person-centred nutrition care to patients with HNC and their carers. Further qualitative research is needed to inform healthcare professionals about the needs of patients and carers to provide appropriate support throughout the treatment trajectory across and between different treatment modalities.
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7
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Thomas A, Sowerbutts AM, Burden ST. The impact of home enteral feeding on the daily lives of people with head and neck cancer: a metasynthesis of qualitative studies. J Hum Nutr Diet 2019; 33:538-549. [DOI: 10.1111/jhn.12724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Thomas
- Wirral Community Health and Care NHS Foundation Trust Victoria Central Health Centre Birkenhead UK
| | | | - S. T. Burden
- School of Health Science University of Manchester Manchester UK
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8
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The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review. Clin Nutr ESPEN 2019; 33:66-85. [DOI: 10.1016/j.clnesp.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/30/2019] [Accepted: 07/09/2019] [Indexed: 01/08/2023]
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9
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Hazzard E, Walton K, McMahon A, Milosavljevic M, Tapsell L. Healthcare Professionals’ Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments. JPEN J Parenter Enteral Nutr 2019; 44:796-805. [DOI: 10.1002/jpen.1699] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 08/17/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Emily Hazzard
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Walton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
| | | | - Marianna Milosavljevic
- Wollongong HospitalIllawarra Shoalhaven Local Health District Wollongong New South Wales Australia
| | - Linda Tapsell
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research InstituteUniversity of Wollongong Wollongong New South Wales Australia
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10
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Gilbertson-White S, Yeung C, Wickersham KE. "Just Living With Them": Symptom Management Experiences of Rural Residents With Advanced Cancer. Oncol Nurs Forum 2019; 46:531-542. [PMID: 31424451 DOI: 10.1188/19.onf.531-542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand how rural residents with advanced cancer experience and manage their symptoms. PARTICIPANTS & SETTING 16 adult patients with a diagnosis of advanced cancer, who were receiving antineoplastic treatment and living in rural areas of southeastern Iowa, participated in the study. METHODOLOGIC APPROACH Data were collected through semistructured, audio-recorded interviews using open-ended questions. Data were analyzed using content and dimensional analyses. FINDINGS Four themes were developed from the completed interviews, including (a) barriers and challenges associated with rural cancer care, (b) physical symptoms experienced from the time of diagnosis through the cancer trajectory, (c) symptom management strategies used to control physical symptoms, and (d) perceptions of having cancer and the use of technology in managing symptoms. IMPLICATIONS FOR NURSING Rural residents with advanced cancer experience a wide range of physical symptoms that may affect their quality of life. Although residents may develop self-management strategies to cope with symptoms, additional guidance on and interventions for how best to manage physical symptoms are needed.
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11
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Thomas A, Sowerbutts AM, Burden ST. The impact of living with home enteral feeding: perspectives of people who have had a diagnosis of head and neck cancer. J Hum Nutr Diet 2019; 32:676-683. [DOI: 10.1111/jhn.12691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Thomas
- Wirral Community Health and Care NHS Foundation Trust Victoria Central Hospital Wallasey UK
| | | | - S. T. Burden
- School of Health Science University of Manchester Manchester UK
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12
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Green SM, Townsend K, Jarrett N, Westoby C, Fader M. People with enteral tubes and their carers' views of living with a tube and managing associated problems: A qualitative interview study. J Clin Nurs 2019; 28:3710-3720. [DOI: 10.1111/jocn.14972] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/27/2019] [Accepted: 06/16/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Sue M. Green
- School of Health Sciences University of Southampton Southampton UK
| | - Kay Townsend
- School of Health Sciences University of Southampton Southampton UK
| | - Nikki Jarrett
- School of Health Sciences and Social Work University of Portsmouth Portsmouth UK
| | | | - Mandy Fader
- School of Health Sciences University of Southampton Southampton UK
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13
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Patients' experience of enteral feeding following (chemo) radiotherapy for head and neck cancer: A qualitative study. Clin Nutr 2019; 38:1382-1389. [DOI: 10.1016/j.clnu.2018.06.958] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 04/05/2018] [Accepted: 06/08/2018] [Indexed: 11/19/2022]
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14
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Ang SY, Lim ML, Ng XP, Lam M, Chan MM, Lopez V, Lim SH. Patients and home carers' experience and perceptions of different modalities of enteral feeding. J Clin Nurs 2019; 28:3149-3157. [DOI: 10.1111/jocn.14863] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/21/2019] [Accepted: 03/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shin Yuh Ang
- Division of Nursing Singapore General Hospital Singapore Singapore
| | - Mei Ling Lim
- Neuroscience Research Australia Sydney New South Wales Australia
| | - Xin Ping Ng
- Division of Nursing Singapore General Hospital Singapore Singapore
| | - Madeleine Lam
- Division of Nursing Nursing Home Nursing Foundation Singapore Singapore
| | - Mei Mei Chan
- Division of Nursing Nursing Home Nursing Foundation Singapore Singapore
| | - Violeta Lopez
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore
- National University Health System Singapore Singapore
| | - Siew Hoon Lim
- Division of Nursing Singapore General Hospital Singapore Singapore
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15
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Green SM, Townsend K, Jarrett N, Fader M. The experiences and support needs of people living at home with an enteral tube: a qualitative interview study. J Hum Nutr Diet 2019; 32:646-658. [DOI: 10.1111/jhn.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- S. M. Green
- School of Health Sciences University of Southampton Highfield, Southampton UK
- Solent NHS Trust Hampshire UK
| | - K. Townsend
- School of Health Sciences University of Southampton Highfield, Southampton UK
| | - N. Jarrett
- School of Health Sciences and Social Work University of Portsmouth Portsmouth UK
| | - M. Fader
- School of Health Sciences University of Southampton Highfield, Southampton UK
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16
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Paleri V, Patterson J, Rousseau N, Moloney E, Craig D, Tzelis D, Wilkinson N, Franks J, Hynes AM, Heaven B, Hamilton D, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Stocken D. Gastrostomy versus nasogastric tube feeding for chemoradiation patients with head and neck cancer: the TUBE pilot RCT. Health Technol Assess 2019; 22:1-144. [PMID: 29650060 DOI: 10.3310/hta22160] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Approximately 9000 new cases of head and neck squamous cell cancers (HNSCCs) are treated by the NHS each year. Chemoradiation therapy (CRT) is a commonly used treatment for advanced HNSCC. Approximately 90% of patients undergoing CRT require nutritional support via gastrostomy or nasogastric tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date (at the time of writing), not been compared. The aim of this pilot randomised controlled trial (RCT) was to compare these two options. METHODS This was a mixed-methods multicentre study to establish the feasibility of a RCT comparing oral feeding plus pre-treatment gastrostomy with oral feeding plus as-required nasogastric tube feeding in patients with HNSCC. Patients were recruited from four tertiary centres treating cancer and randomised to the two arms of the study (using a 1 : 1 ratio). The eligibility criteria were patients with advanced-staged HNSCC who were suitable for primary CRT with curative intent and who presented with no swallowing problems. MAIN OUTCOME MEASURES The primary outcome was the willingness to be randomised. A qualitative process evaluation was conducted alongside an economic modelling exercise. The criteria for progression to a Phase III trial were based on a hypothesised recruitment rate of at least 50%, collection of outcome measures in at least 80% of those recruited and an economic value-of-information analysis for cost-effectiveness. RESULTS Of the 75 patients approached about the trial, only 17 consented to be randomised [0.23, 95% confidence interval (CI) 0.13 to 0.32]. Among those who were randomised, the compliance rate was high (0.94, 95% CI 0.83 to 1.05). Retention rates were high at completion of treatment (0.94, 95% CI 0.83 to 1.05), at the 3-month follow-up (0.88, 95% CI 0.73 to 1.04) and at the 6-month follow-up (0.88, 95% CI 0.73 to 1.04). No serious adverse events were recorded in relation to the trial. The qualitative substudy identified several factors that had an impact on recruitment, many of which are amenable to change. These included organisational factors, changing cancer treatments and patient and clinician preferences. A key reason for the differential recruitment between sites was the degree to which the multidisciplinary team gave a consistent demonstration of equipoise at all patient interactions at which supplementary feeding was discussed. An exploratory economic model generated from published evidence and expert opinion suggests that, over the 6-month model time horizon, pre-treatment gastrostomy tube feeding is not a cost-effective option, although this should be interpreted with caution and we recommend that this should not form the basis for policy. The economic value-of-information analysis indicates that additional research to eliminate uncertainty around model parameters is highly likely to be cost-effective. STUDY LIMITATIONS The recruitment issues identified for this cohort may not be applicable to other populations undergoing CRT. There remains substantial uncertainty in the economic evaluation. CONCLUSIONS The trial did not meet one of the three criteria for progression, as the recruitment rate was lower than hypothesised. Once patients were recruited to the trial, compliance and retention in the trial were both high. The implementation of organisational and operational measures can increase the numbers recruited. The economic analysis suggests that further research in this area is likely to be cost-effective. FUTURE WORK The implementation of organisational and operational measures can increase recruitment. The appropriate research question and design of a future study needs to be identified. More work is needed to understand the experiences of nasogastric tube feeding in patients undergoing CRT. TRIAL REGISTRATION Current Controlled Trials ISRCTN48569216. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospital, London, UK.,Division of Clinical Studies, Institute of Cancer Research, London, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne, UK
| | - Joanne Patterson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Eoin Moloney
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Dimitrios Tzelis
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilkinson
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Franks
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Marie Hynes
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - Ben Heaven
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - David Hamilton
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Rachael Donnelly
- Department of Radiation Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stewart Barclay
- Department of Restorative Dentistry, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Deborah Stocken
- Biostatistics Research group, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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17
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Examining the role of patient values in decisions about long-term enteral feeding: A qualitative study. Clin Nutr 2018; 37:1046-1052. [DOI: 10.1016/j.clnu.2017.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/17/2017] [Accepted: 04/30/2017] [Indexed: 11/19/2022]
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18
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Greaves JR. Head and Neck Cancer Tumor Seeding at the Percutaneous Endoscopic Gastrostomy Site. Nutr Clin Pract 2018; 33:73-80. [PMID: 29323421 DOI: 10.1002/ncp.10021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/10/2017] [Indexed: 01/14/2023] Open
Abstract
The National Institutes of Health National Cancer Institute estimates that over 13,000 new cases of head and neck cancer (HNC) will be diagnosed in 2017. Patients with HNC often require enteral nutrition (EN) via gastrostomy tube to provide nutrition support and hydration because of tumor obstruction of the oropharynx and/or cumulative effects of chemoradiation therapy. The percutaneous endoscopic gastrostomy (PEG) tube has become the preferred technique for EN access because placement is considered a minimally invasive procedure. There are 3 methods of PEG placement: Gauderer-Ponsky "pull," Sachs-Vine "push," and Russell "push" method. The Gauderer-Ponsky "pull" method has become the preferred method of PEG placement. It has been previously reported that the rate of stomal metastasis can be 0.5%-1% of those undergone the Gauderer-Ponsky "pull" method that is consistent with HNC morphology. Other researchers believe the rate may be as high as 0.5%-3%. This article reviews the 3 methods of PEG placement, as well as all potential complications, including metastatic seeding at the PEG site. In addition, 1 additional case of tumor seeding at the PEG site will be reviewed. Consideration for avoidance of the Gauderer-Ponsky pull method of PEG placement or other methods of feeding tube placement where the gastrostomy tube has to pass through the oral cavity before exiting the abdominal wall in patients with squamous cell carcinoma of the head and neck should be considered.
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Affiliation(s)
- June R Greaves
- Coram CVS Specialty Infusion Services, Denver, Colorado, USA
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19
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Kurien M, Andrews RE, Tattersall R, McAlindon ME, Wong EF, Johnston AJ, Hoeroldt B, Dear KL, Sanders DS. Gastrostomies Preserve But Do Not Increase Quality of Life for Patients and Caregivers. Clin Gastroenterol Hepatol 2017; 15:1047-1054. [PMID: 27840184 DOI: 10.1016/j.cgh.2016.10.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/07/2016] [Accepted: 10/31/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Gastrostomies are widely used to provide long-term enteral nutrition to patients with neurologic conditions that affect swallowing (eg, following a cerebrovascular accident or for patients with motor neuron disease) or with oropharyngeal malignancies. The benefits derived from this intervention are uncertain for patients and caregivers. We conducted a prospective, multicenter cohort study to determine how gastrostomies affect health-related quality of life (HRQoL) in recipients and caregivers. METHODS We performed a study of 100 patients who received gastrostomies (55% percutaneous endoscopic gastrostomy, 45% radiologically inserted) at 5 centers in the United Kingdom, 100 caregivers, and 200 population control subjects. We used the EuroQol-5D (comprising a questionnaire, index, visual analogue scale) to assess HRQoL for patients and caregivers before the gastrostomy insertion and then 3 months afterward; findings were compared with those from control subjects. Ten patients and 10 caregivers were also interviewed after the procedure to explore quantitative findings. Findings from the EuroQol-5D and semi-structured interviews were integrated using a mixed-methods matrix. RESULTS Six patients died before the 3-month HRQoL reassessments. We observed no significant longitudinal changes in mean EuroQol-5D index scores for patients (0.70 before vs 0.710 after; P = .83) or caregivers (0.95 before vs 0.95 after; P = .32) following gastrostomy insertion. The semi-structured interviews revealed problems in managing gastrostomy tubes, social isolation, and psychological and emotional consequences that reduced HRQoL. CONCLUSIONS We performed a mixed-methods prospective study of the effects of gastrostomy feeding on HRQoL. HRQoL did not significantly improve after gastrostomy insertion for patients or caregivers. The lack of significant decrease in HRQoL after the procedure indicates that gastrostomies may help maintain HRQoL. Findings have relevance to those involved in gastrostomy insertion decisions and indicate the importance of carefully selecting patients for this intervention, despite the relative ease of insertion.
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Affiliation(s)
- Matthew Kurien
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Academic Unit of Gastroenterology, University of Sheffield, Sheffield, United Kingdom.
| | - Rebecca E Andrews
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Rachel Tattersall
- Department of Rheumatology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Mark E McAlindon
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Emma F Wong
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Alex J Johnston
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Barbara Hoeroldt
- Department of Gastroenterology, Rotherham General Hospital, Rotherham, United Kingdom
| | - Keith L Dear
- Department of Gastroenterology, Chesterfield Royal Hospital, Chesterfield, United Kingdom
| | - David S Sanders
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom; Academic Unit of Gastroenterology, University of Sheffield, Sheffield, United Kingdom
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Green C, Vandall-Walker V. A Necessary Evil? Patients' Experiences Receiving Tube Feeding in Acute Care. Nutr Clin Pract 2017; 32:516-525. [PMID: 28459649 DOI: 10.1177/0884533617706390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Tube feeding (TF) is frequently prescribed for adults admitted to acute care facilities to prevent or ameliorate malnutrition, yet little is known about patients' needs and experiences with receiving this therapy. Patients' perspectives regarding the factors influencing their experiences, as well as their information and support needs, are required to inform healthcare providers' (HCPs') patient-centered practices. METHODS Based on an interpretive description qualitative approach, 12 unstructured face-to-face interviews were conducted with participants admitted to acute care hospitals in Northwestern Ontario, Canada. RESULTS Analysis of data revealed variations in participants' perceptions of the necessity for TF and the discomfort resulting from this therapy. Perceived necessity was influenced by interrelated themes: the meaning of TF (beyond necessity), the trust held in HCPs, and the resilience of participants in response to all that they were experiencing. Collectively, these findings are encompassed within the central theme, phrased as a question, about the experience of TF: "A necessary evil?" Participants' answers to this question revealed the nature of their overall response throughout TF therapy (ie, indifferent, resistant, relieved, or tolerant). CONCLUSIONS The range of perceptions and the complexity of patients' experiences during TF revealed in the data can inform HCPs' patient-centered approaches to TF care. Assessing and incorporating patients' values, beliefs, needs, and goals into, and exploring their choices in, nutrition care planning can promote resilience in response to TF therapy. HCPs may then well enhance patients' comfort and overall experience with TF therapy.
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Affiliation(s)
- Cara Green
- 1 Faculty of Health Disciplines, Athabasca University, Athabasca, Canada.,2 St Joseph's Care Group, Thunder Bay, Canada.,3 Northern Ontario Dietetic Internship Program, Division of Clinical Sciences, Northern Ontario School of Medicine, Thunder Bay, Canada
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21
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Jaafar MH, Mahadeva S, Subramanian P, Tan MP. Perceptions of Healthcare Professionals on the Usage of Percutaneous Endoscopic Gastrostomy in a Teaching Hospital from a Middle-Income South East Asian Country. J Nutr Health Aging 2017; 21:473-479. [PMID: 28346575 DOI: 10.1007/s12603-016-0774-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore the perceptions of healthcare professionals' (HCPs) in a South East Asian nation towards percutaneous endoscopic gastrostomy (PEG) feeding. DESIGN Semi-structured, qualitative interviews. SETTINGS A teaching hospital in Kuala Lumpur, Malaysia. PARTICIPANTS A total of 17 healthcare professionals aged 23-43 years, 82% women. RESULTS Thematic analysis revealed five themes that represent HCPs' perceptions in relation to the usage of PEG feeding: 1) knowledge of HCPs, 2) communication, 3) understanding among patients, and 4) financial and affordability. CONCLUSION The rationale for reluctance towards PEG feeding observed in this regions was explained by lack of education, knowledge, communication, team work, and financial support. Future studies should assess the effects of educational programmes among HCPs and changes in policies to promote affordability on the utilization of PEG feeding in this region.
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Affiliation(s)
- M H Jaafar
- Maw Pin Tan, MBBS, Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia, Telephone: +6016-3328600 / +603-79493200, Email :
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22
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Systematic review of qualitative and quantitative studies on the attitudes and barriers to percutaneous endoscopic gastrostomy feeding. Clin Nutr 2016; 35:1226-1235. [DOI: 10.1016/j.clnu.2016.04.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 03/16/2016] [Accepted: 04/19/2016] [Indexed: 01/13/2023]
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23
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Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg 2015; 23:162-70. [PMID: 25692626 DOI: 10.1097/moo.0000000000000135] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW This article explores the literature on the role of gastrostomy tube feeding use in the management of head and neck cancer, with special attention to its indications, timing of insertion, advantages, complications and quality of life issues. RECENT FINDINGS The current guidelines in place across different countries and two ongoing randomized controlled trials are discussed in detail, and placed in the context of current evidence. SUMMARY There remains a lack of consensus about when and which enteral feeding routes (gastrostomy or nasogastric tube) should be used and controversy about the long-term effects on swallowing function as well as quality of life for patients. Local guidelines should be used or generated to guide practice or patients enrolled into existing trials until higher level evidence is generated.
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Halliday V, Baker M, Thomas AL, Bowrey D. Patient and Family Caregivers' Experiences of Living With a Jejunostomy Feeding Tube After Surgery for Esophagogastric Cancer. JPEN J Parenter Enteral Nutr 2015; 41:837-843. [PMID: 26318373 PMCID: PMC5534339 DOI: 10.1177/0148607115604114] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Jejunostomy feeding tubes (JFTs) can be used to provide nutrition support to patients who have had surgery for esophagogastric cancer. Although previous research reports how patients cope with a gastrostomy tube, little is known about the impact of having a JFT. The aim of this qualitative study was to explore how patients and their informal caregivers experience living with a JFT in the first months following surgery. METHODS Participants were purposively sampled from a cohort of patients recruited to a trial investigating home enteral nutrition vs standard care after esophagogastric surgery for cancer. The sampling framework considered age, sex, and marital status. Informal caregivers were also invited to participate. Interviews were audio recorded, transcribed verbatim, and anonymized. Inductive thematic analysis was used to identify key themes related to living with a JFT. RESULTS Fifteen patient interviews were conducted; 8 also included a family caregiver. Analysis of the data resulted in 2 main themes: "challenges" and "facilitators" when living with a JFT. While "physical effects," "worries" and "impact on routine" were the main challenges, "support," "adaptation" and "perceived benefit" were what motivated continuation of the intervention. CONCLUSION Findings suggest that participants coped well with a JFT, describing high levels of compliance with stoma care and the feeding regimen. Nonetheless, disturbed sleep patterns and stoma-related problems proved troublesome. A better understanding of these practical challenges, from the patient and family caregiver perspective, should guide healthcare teams in providing proactive support to avoid preventable problems.
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Affiliation(s)
- Vanessa Halliday
- 1 The School of Health and Related Research (ScHARR), University of Sheffield, UK
| | - Melanie Baker
- 2 Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Anne L Thomas
- 3 Department of Cancer Studies, University of Leicester, Leicester, UK
| | - David Bowrey
- 2 Department of Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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