A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

Rattray, Megan; Marshall, Andrea P.; Desbrow, Ben; Roberts, Shelley

doi:10.1111/jhn.12596

Cited by 14 publications

(26 citation statements)

References 29 publications

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“…In fact, only a minority of surgeons described factoring patients’ food preferences and nausea or hunger ratings into their decision-making, while several stated they were better positioned to determine patients’ dietary needs. However, when patients participate in their care they have better outcomes and are more satisfied with their care [36, 37]. Given the relationship between shared decision-making and evidence-based practice is becoming increasingly recognised, strategies to support clinicians in enacting a more patient-centred approach are required.…”

Section: Discussionmentioning

confidence: 99%

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

Rattray

Roberts

Desbrow

et al. 2019

BMC Health Serv Res

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BackgroundEnhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions.MethodsThis qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation.ResultsTwenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition.ConclusionsIndividual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs’ decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-4011-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

Rattray

Roberts

Desbrow

et al. 2019

BMC Health Serv Res

Self Cite

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“…The abdominal pathology of surgical management is characterized by gastrointestinal discomfort, counteracted by the person by eating very little or by not eating, measures that generate physical decay and emotional changes in the person. Said findings are related with the qualitative study by Rattray et al, (15) that explored the experiences of patients when starting the feeding process after colorectal surgery. The research revealed that some participants, when experiencing nausea due to the surgical pathology, undertake a series of actions to mitigate the symptom, like, modifying the diet, giving up on foods they normally eat and selecting those they can swallow independent of the enjoyment or avoiding eating food completely.…”

Section: Discussionmentioning

confidence: 81%

Meaning of Receiving Artificial Nutritional Support in People in the Postoperative Period of Abdominal Surgery

González¹,

Ramírez²

2020

invest. educ. enferm

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Objective. This work sought to describe the meaningof receiving artificial nutritional support in people in thepostoperative period of abdominal surgery. Methods.This was a qualitative study of grounded theory, followingthe guidelines by Corbin and Strauss. The informationwas collected through 26 in-depth interviews with 21participants, interned in a tier III health care hospital inthe city of Tunja, Colombia. Results. The study describesfour categories, which account for the way in which theperson experiences physical, physiological, emotional,and social changes when receiving artificial nutritionalsupport. The categories include stopping eating andbecoming artificially fed, decreasing the ability to moveto recover movement, experiencing the difficulty of having artificial nutritional support, and reaching the disease to transform life. The dataanalysis shows that the basic surgical pathology and the artificial nutritional supportare sudden events that fragment the daily life of the person. These individualsdemand the mobilization of religious, family, and social resources to strengthen theperson’s internal and external environment and, thus, achieve the health situation. Conclusions. The analysis of the meanings shows how the person reflects andinterprets the reality of receiving artificial nutritional support, an event that hasimplicit physical discomfort, emotional changes, and physical appearance, whichare determinants in the behavior and practice of artificial nutrition. However,artificial nutritional support becomes for the person an alternative to live and recoverthe state of health.

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“…However, tolerance of solid food on POD 1 or 2 was much poorer. We did not formally explore reasons for this, but a recent qualitative investigation from Australia provided an insight into the experiences and perceptions of post-operative feeding in people who had undergone colorectal surgery (17). In addition to service-level factors, several patient-related factors may influence whether or not people eat, or indeed tolerate, early oral feeding.…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative investigations in colorectal surgery populations have shown that people associate post-operative feeding with a sense of returning to 'normality' (17,18), but reported mixed views on when people were willing to commence solid foods (i.e., sooner or later than when prescribed) (17).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with early postoperative feeding: An observational study in a colorectal surgery population

Atkinson

Monk

Ness

et al. 2020

Clinical Nutrition ESPEN

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Background and aims: Early post-operative feeding is recommended within enhanced recovery after surgery programmes. This study aimed to describe post-operative feeding patterns and associated factors among patients following colorectal surgery, using a post-hoc analysis of observational data from a previous RCT on chewing gum after surgery. Methods: Data from 301 participants (59% male, median age 67y) were included. Amounts of meals consumed on post-operative days (POD) 1-5 were recorded as: none, a quarter, half, three-quarters, all. 'Early' consumers were those who ate ≥ a quarter of a meal on POD1. 'Early' tolerance was the consumption of at least half of three meals on POD1 or 2 without vomiting. Exploration of selected peri-operative factors with early feeding and tolerance were assessed using logistic regression. Results: 222 people (73.8%) consumed solid food early, and 109 people (36.2%) tolerated solid food early. Several factors were associated with postoperative feeding: provision of preoperative bowel preparation was associated with delayed consumption [odds ratio (OR) 0.34, 95% confidence interval (CI) 0.14-0.83] and tolerance (OR 0.35, 95% CI 0.16-0.81) of food; and laparoscopic/laparoscopic assisted (vs. open/converted to open surgery) was associated with early tolerance of food (OR 1.99, 95% CI 1.17-3.39). Conclusions: While three-quarters of the study population ate solid food early, only one-third tolerated solid food early. Findings suggest that bowel preparation and surgery type are factors warranting further investigation in future studies to improve uptake of early postoperative feeding.

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A qualitative exploration of patients’ experiences with and perceptions of recommencing feeding after colorectal surgery

Cited by 14 publications

References 29 publications

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

Meaning of Receiving Artificial Nutritional Support in People in the Postoperative Period of Abdominal Surgery

Factors associated with early postoperative feeding: An observational study in a colorectal surgery population

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