Identifying the Barriers and Enablers to Nutrition Care in Head and Neck and Esophageal Cancers: An International Qualitative Study
Identifying the Barriers and Enablers to Nutrition Care in Head and Neck and Esophageal Cancers: An International Qualitative Study
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DOI：
10.1177/0148607114552847
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发表时间：
2016-03-01
影响因子：
3.4
通讯作者：
Gramlich, Leah
中科院分区：
文献类型：
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作者：
Martin, Lisa;de van der Schueren, Marian A. E.;Gramlich, Leah
背景：这项工作的目标是确定在头颈部和食道癌(HNE)中实施营养护理的障碍和促进因素，并确定障碍的优先顺序，以帮助改善营养护理过程。材料和方法：本研究采用多方法定性研究设计(包括半结构式访谈、焦点小组)。访谈(n=29)在欧洲5个为HNE癌症患者提供护理和治疗的地点进行。一个焦点小组(n=21)回顾并证实了访谈结果，并确定了营养护理的优先事项。参与者是在HNE癌症领域有直接经验的医疗保健提供者和研究人员。结果：确定了与营养护理相关的五个主题：(1)营养干预的益处的证据，(2)营养护理过程的实施(评估、干预和随访)，(3)保健提供者的特征，(4)场地因素，(5)患者特征。焦点小组讨论确定了改善营养护理必须采取行动的两个优先事项：(1)改善证据基础和(2)发展标准化的营养护理途径。结论：与HNE癌症患者的营养护理相关的主题在不同的地点是相似的，但障碍和促进因素不同。访谈和焦点小组与会者一致认为，以下行动将导致营养护理的改善：(1)加强证据基础，以测试营养干预的益处，重点是解决与营养治疗有关的具体争议，以及(2)建立最低数据集，目标是创建标准化的营养护理途径，其中明确界定护理的作用和责任。
Background: The goal of this work was to identify barriers and enablers to the implementation of nutrition care in head and neck and esophageal (HNE) cancers and to prioritize barriers to help improve the nutrition care process. Materials and Methods: This study used a multimethod qualitative study design (including semistructured interviews, focus group). Interviews (n = 29) were conducted at 5 European sites providing care and treatment to patients with HNE cancers. A focus group (n = 21) reviewed and corroborated interview findings and identified priorities for nutrition care. Participants were healthcare providers and researchers with direct experience in the field of HNE cancer. Results: Five themes with accompanying barriers and enablers were identified related to nutrition care: (1) evidence for the benefit of nutrition interventions, (2) implementation of nutrition care processes (assessment, intervention, and follow-up), (3) characteristics of healthcare providers, (4) site factors, and (5) patient characteristics. Focus group discussions identified 2 priorities that must be acted on to improve nutrition care: (1) improve the evidence base and (2) develop standardized nutrition care pathways. Conclusion: Themes related to nutrition care in HNE cancers were similar between sites, but barriers and enablers differed. Interview and focus group participants agreed the following actions will result in improvements in nutrition care: (1) enhance the evidence base to test the benefit of nutrition interventions, with a focus on resolving specific controversies regarding nutrition therapy, and (2) establish a minimum data set with a goal to create standardized nutrition care pathways where roles and responsibilities for care are clearly defined.