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

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Faculty of Medicine, Biology and Health, and Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
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The Christie NHS Foundation Trust, Manchester M20 4BX, UK
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Wythenshawe Hospital, University Hospital of South Manchester, Manchester University NHS Foundation Trust, M23 9LT Manchester, UK
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Population Health Sciences, Bristol Medical School, University of Bristol, Bristol BS8 2PS, UK
*
Author to whom correspondence should be addressed.
Nutrients 2020, 12(1), 166; https://doi.org/10.3390/nu12010166
Received: 29 November 2019 / Accepted: 25 December 2019 / Published: 7 January 2020
(This article belongs to the Section Clinical Nutrition)
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. View Full-Text
Keywords: decision-making; parenteral nutrition; home; ovarian neoplasms; qualitative research decision-making; parenteral nutrition; home; ovarian neoplasms; qualitative research
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Sowerbutts, A.M.; Lal, S.; Sremanakova, J.; Clamp, A.R.; Jayson, G.C.; Teubner, A.; Hardy, L.; Todd, C.; Raftery, A.-M.; Sutton, E.; Burden, S. Discharging Women with Advanced Ovarian Cancer on Home Parenteral Nutrition: Making and Implementing the Decision. Nutrients 2020, 12, 166.

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