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

Anne Marie Sowerbutts*, Simon Lal, Jana Sremanakova, Andrew R. Clamp, Gordon C. Jayson, Antje Teubner, Lisa Hardy, Chris Todd, Anne Marie Raftery, Eileen Sutton, Sorrel Burden

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

2 Citations (Scopus)
83 Downloads (Pure)

Abstract

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.

Original languageEnglish
Article number166
Number of pages9
JournalNutrients
Volume12
Issue number1
DOIs
Publication statusPublished - 7 Jan 2020

Keywords

  • Decision-making
  • Home
  • Ovarian neoplasms
  • Parenteral nutrition
  • Qualitative research

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