Attitudes towards weight and weight assessment in oncology patients: survey of hospice staff and patients with advanced cancer

Abstract

The objective of this study was to compare attitudes of hospice staff towards weight loss and weight assessment in the hospice setting with those of patients with advanced malignancy in the hospital outpatient setting. Two paper-based questionnaires (one for staff and one for patients) were designed. The staff survey was circulated to all hospices in the UK and Ireland, and the patient questionnaire was given to patients attending three oncological care clinics in Belfast, Northern Ireland; Wolverhampton, England; and Auckland, New Zealand. The staff survey was posted to the medical director of each of the 215 hospices in the UK and Ireland. A total of 129 oncology outpatients with a confirmed diagnosis of malignancy and no longer receiving curative oncological interventions took part in the questionnaire. The main outcome measure was descriptive information about hospice weighing practices and attitudes of hospice staff towards weighing patients, and descriptive information was collected about patient attitudes to weighing and weight loss. We found that weighing practices vary across hospices in UK and Ireland. Patients attending the majority of hospices, 96/146 (66%), are rarely weighed. A little over half of hospice staff, 81/146 (56%) considered that weighing could cause patients to be upset. However, 124/129 (96%) of patients with advanced cancer reported that they had never found the experience of being weighed in a healthcare facility upsetting. Some 95/129 (74%) of patients weighed themselves at home and 89% would want to know if their weight was changing. While there is reluctance on the part of many hospice staff to weigh patients, most patients with advanced malignancy in the hospital setting do not report weight measurement to be upsetting.

Recording patient bodyweight in hospitals: are we doing well enough?

“…Errors in medication dose administration have the potential to lead to adverse outcomes . Doses are regularly calculated based on patient weight, particularly for medications with a narrow therapeutic index, in patients with renal dysfunction and in the paediatric population .…”

“…Others have proposed that weighing patients may be distressing for the patient and would not change management. In a qualitative study in a UK hospice with terminally ill patients, staff did not want patients thinking about their weight during palliative care, with 55% declaring a desire not to weigh patients . This indicates that in areas of health such as end of life care, recording patient weight may be considered futile or unimportant.…”

“…There are no blinded, randomised control studies in this area, and available studies suffer from biases that commonly occur in retrospective and non‐blinded observational cohort studies . For example, patients may not have been weighed because they had more pre‐existing co‐morbidities confining them to bed, creating practical difficulties in facilitating the weighing process . Studies describing consequences of excess thrombolytic administration such as bleeding were underpowered and limited to single or few centres in one region, making it potentially difficult to generalise results to other populations …”

“…This includes accurate prescribing, fluid assessment, nutritional and obesity screening and safe patient lifting practices . Most research regarding weighing of hospitalised patients is from the United States (US) and the United Kingdom (UK) with only limited data from Australia . Data reveal that in a variety of hospital settings, including the emergency department (ED), intensive care unit (ICU), medical and surgical wards, staff compliance with best practice of weighing patients ranges between 13.5 and 55% …”

Nutrition and palliative care

“…Although weight loss will not be fully reversible for most patients with palliative disease, they do appreciate acknowledgement of it and advice to minimise its progression (Watson et al., 2010). The nutritional assessment tool that is most commonly cited is the ‘malnutrition universal screening tool’ (MUST) for adults; it was developed for application in a variety of healthcare settings and patient groups.…”