Health care providers’ experiences of positive and negative effects of parenteral nutrition therapy in cancer patients

Abstract

Background: As of today, health care provider's (HCP) have little evidence in research to guide decisions for parenteral nutrition (PN) therapy in cancer patients. Uncertainties prevail concerning both the initiation and the duration of the treatment, as well as the benefits of the intervention. The aim of this study was to explore community HCP's experiences of benefits and challenges with PN in cancer patients. Method(s): An 18-itemonline survey was emailed to 309 community care HCP. In two of the questions, respondents were asked to describe in free text their positive and negative experiences with PN therapy in cancer patients, and these answers were analysed by use of content analysis. Result(s): Out of total 135 responses, 102 (75.6%) reported experience with cancer patients receiving PN and completed the entire survey. The majority of the respondents were female (93%); nurses/cancer nurses (86.4%); and worked in home care (48.5%) or nursing homes (37.9%). The most common positive effect of PN reported was an impression that it increased patients' quality of life through increased vitality, increased hope and the ability to spend time at home (reported by 40.2%). Other reported positive effects were the experience that PN improved tolerance to, and enhanced recovery after, cancer treatment; reduced the family's eating-related distress; and was regarded a good treatment alternative for patients with symptoms such as swallowing problems, nausea or obstruction. The most common negative effect reported was the difficulties of knowing when to terminate PN, primarily because this removes patients' and family's hope (reported by 26.4%). Poor information to patients and their family at initiation of PN, made termination even more difficult. PN therapy was also reported to cause side effects such as fluid retention and oedema and prolong suffering at end of life. Conclusion(s): Despite a limited evidence-base in support of benefits of PN treatment in cancer patients, HCP in this study reported several positive effects based on their clinical experience. Some of the positive effects were related to earlier phases of the disease, while the negative effects mainly regarded communication and decision challenges when ending PN therapy at the end of life.