TY - JOUR
T1 - Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition
T2 - Making and Implementing the Decision
AU - Sowerbutts, Anne Marie
AU - Lal, Simon
AU - Sremanakova, Jana
AU - Clamp, Andrew R.
AU - Jayson, Gordon C.
AU - Teubner, Antje
AU - Hardy, Lisa
AU - Todd, Chris
AU - Raftery, Anne Marie
AU - Sutton, Eileen
AU - Burden, Sorrel
PY - 2020/1/7
Y1 - 2020/1/7
N2 - 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.
AB - 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.
KW - Decision-making
KW - Home
KW - Ovarian neoplasms
KW - Parenteral nutrition
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=85077869692&partnerID=8YFLogxK
U2 - 10.3390/nu12010166
DO - 10.3390/nu12010166
M3 - Article (Academic Journal)
C2 - 31936057
SN - 2072-6643
VL - 12
JO - Nutrients
JF - Nutrients
IS - 1
M1 - 166
ER -