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Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision

Increasingly, 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...

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Autores principales: Sowerbutts, Anne Marie, Lal, Simon, Sremanakova, Jana, Clamp, Andrew R., Jayson, Gordon C., Teubner, Antje, Hardy, Lisa, Todd, Chris, Raftery, Anne-Marie, Sutton, Eileen, Burden, Sorrel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019843/
https://www.ncbi.nlm.nih.gov/pubmed/31936057
http://dx.doi.org/10.3390/nu12010166
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author Sowerbutts, Anne Marie
Lal, Simon
Sremanakova, Jana
Clamp, Andrew R.
Jayson, Gordon C.
Teubner, Antje
Hardy, Lisa
Todd, Chris
Raftery, Anne-Marie
Sutton, Eileen
Burden, Sorrel
author_facet Sowerbutts, Anne Marie
Lal, Simon
Sremanakova, Jana
Clamp, Andrew R.
Jayson, Gordon C.
Teubner, Antje
Hardy, Lisa
Todd, Chris
Raftery, Anne-Marie
Sutton, Eileen
Burden, Sorrel
author_sort Sowerbutts, Anne Marie
collection PubMed
description Increasingly, 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.
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spelling pubmed-70198432020-03-09 Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision Sowerbutts, Anne Marie Lal, Simon Sremanakova, Jana Clamp, Andrew R. Jayson, Gordon C. Teubner, Antje Hardy, Lisa Todd, Chris Raftery, Anne-Marie Sutton, Eileen Burden, Sorrel Nutrients Article Increasingly, 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. MDPI 2020-01-07 /pmc/articles/PMC7019843/ /pubmed/31936057 http://dx.doi.org/10.3390/nu12010166 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Sowerbutts, Anne Marie
Lal, Simon
Sremanakova, Jana
Clamp, Andrew R.
Jayson, Gordon C.
Teubner, Antje
Hardy, Lisa
Todd, Chris
Raftery, Anne-Marie
Sutton, Eileen
Burden, Sorrel
Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title_full Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title_fullStr Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title_full_unstemmed Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title_short Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision
title_sort discharging women with advanced ovarian cancer on home parenteral nutrition: making and implementing the decision
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019843/
https://www.ncbi.nlm.nih.gov/pubmed/31936057
http://dx.doi.org/10.3390/nu12010166
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