Discharging women with advanced ovarian cancer on home parenteral nutrition: making and implementing the decision
Clamp, Andrew R
Jayson, Gordon C
AffiliationFaculty of Medicine, Biology and Health, and Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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AbstractIncreasingly, patients with advanced ovarian cancer in bowel obstruction are receiving home parenteral nutrition (HPN). Little is known about making and implementing the decision. This study explored the decision-making process for HPN and investigated the barriers and facilitators to implementation. This was a qualitative study underpinned by phenomenology involving 93 longitudinal in-depth interviews with 20 patients, their relatives and healthcare professionals, over 15 months. Participants were interviewed a maximum of four times. Interview transcripts were analysed thematically as per the techniques of Van Manen. We found variance between oncologists and patients regarding ownership of the HPN decision. The oncologists believed they were engaging in a shared decision-making process. However, patients felt that the decision was oncologist-driven. Nevertheless, they were content to have the treatment, when viewing the choice as either HPN or death. In implementing the decision, the principal mutable barrier to a timely discharge was communication difficulties across professional disciplines and organisations. Facilitators included developing a single point-of-contact between organisations, improving communication and implementing standardised processes. Oncologists and patients differ in their perceptions of how treatment decisions are made. Although patients are satisfied with the process, it might be beneficial for healthcare professionals to check patients' understanding of treatment.
CitationSowerbutts AM, Lal S, Sremanakova J, Clamp AR, Jayson GC, Teubner A, et al. Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision. Nutrients. 2020;12(1).
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- Issue date: 2020 Aug
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- Authors: Sowerbutts AM, Lal S, Sremanakova J, Clamp AR, Jayson GC, Teubner A, Hardy L, Todd C, Raftery AM, Sutton E, Morgan RD, Vickers AJ, Burden S
- Issue date: 2019 Dec 29
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- Authors: Ennis L, Ablett J, Taylor M, Lal S
- Issue date: 2018 Aug
- Identifying patient-centered quality indicators for the care of adult home parenteral nutrition (HPN) patients.
- Authors: Dreesen M, Foulon V, Vanhaecht K, De Pourcq L, Hiele M, Willems L
- Issue date: 2014 Sep
- A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition.
- Authors: Bond A, Teubner A, Taylor M, Willbraham L, Gillespie L, Farrer K, McMahon M, Leahy G, Abraham A, Soop M, Clamp AR, Hasan J, Mitchell C, Jayson GC, Lal S
- Issue date: 2019 Aug