Assessment of compliance with oral nutritional supplementation and exploration of barriers and facilitators for patients after gastrectomy: A mixed‐methods study

Abstract

Aims To evaluate the compliance of patients after gastrectomy in taking oral nutritional supplementation and to explore the promoting and hindering factors. Design A mixed‐methods design with an explanatory sequential approach was employed. Methods We conducted a 12‐week longitudinal study to evaluate the oral nutritional supplementation compliance of 122 patients after gastric cancer surgery and the factors that affected their compliance. After the quantitative phase, we selected the interview subjects and developed the interview outline based on the analysis of the quantitative results. In‐depth interviews (n = 15) were conducted to explain and supplement the quantitative phase results. Data were collected from October 2019 to May 2020. Results The average overall compliance rate of oral nutritional supplementation in patients with gastric cancer over 12 weeks was 30.59%. Adverse reactions to oral nutritional supplementation, the identity of the main caregivers and the patient's financial ability were independent factors that affected patient compliance. In subsequent interviews, we extracted four themes: social support plays an important role in patients taking oral nutritional supplementation, adverse reactions discourage patients from continuing to take oral nutritional supplementation, patients' attitudes affect their motivation to take oral nutritional supplementation, and the different needs of patients for oral nutritional supplementation affect patient compliance. Conclusion Patients' compliance with oral nutritional supplementation after gastric cancer surgery is very low. Health education should pay more attention to the management of adverse reactions and the role of patients' peers and family members. Oral nutritional supplementation products should be diversified to provide patients with more choices. Impact This study clarifies the factors that hinder and promote oral nutritional supplementation compliance and provides an important reference for the establishment and revision of health education strategies for patients after gastric cancer surgery.

Vitamin B12 supplementation post-gastrectomy: a service closed-loop audit at St. James’s Hospital, Dublin

“…The ‘ Nutrition and Survivorship Clinic ’ from our tertiary cancer centre, in Oesophageal and Gastric Cancer, has demonstrated a high prevalence of iron deficiency, iron deficiency anaemia and vitamin D deficiency at 1-year post-surgery [ 12 ]. Although there is a large amount of data available on morbidity, mortality and major complications post-gastrectomy, there is inconsistent and often conflicting data focusing on postoperative nutrition and patient adherence with their new nutritional regime [ 14 , 20 – 22 ]. This can in turn affect the overall survival and quality-of-life outcomes of the patient.…”

Preferences for oral nutritional supplement therapy among postoperative patients with gastric cancer: a discrete choice experiment

“…In our study, 33.16% of postoperative patients had experienced symptoms of gastrointestinal discomfort during ONS treatment. Diarrhea may be related to the rapid passage of high osmotic pressure nutrient solution through the intestine due to the patient eating too fast [ 13 ]. ONS should begin with a low concentration and low volume to minimize diarrhea.…”

“…Previous studies have shown that patients in the high-compliance group have significantly improved nutritional status compared with those in the low-compliance group [ 10 , 11 ]. ONS compliance is sometimes not satisfactory, and the compliance of patients with ONS after gastrectomy was even only 26.20–58.00% [ 10 , 12 , 13 ]. A recent longitudinal study in China found that the average compliance of patients after gastrectomy at 12 weeks was as low as 30.59%, and did not find a clear advantage of ONS in reducing the incidence of complications in patients, which affected the prognosis of patients [ 13 ].…”

“…Previous studies have shown that the main reason for the discontinuation of ONS was gastrointestinal intolerance [ 15 ]. A longitudinal study found that adverse reactions to ONS, the identity of the main caregivers, and the patient’s financial ability were independent factors that affected patient compliance in China [ 13 ]. Support from patients’ family members and peers will also influence patient compliance.…”

Implications of inappropriate prescription of oral nutritional supplements on the quality of life of cancer outpatients: a cross-sectional comparative study

“…One study concluded that the compliance of cancer patients was low for ONS intake, and therefore, it may affect patients’ weight loss. Hence, it was suggested that education strategies should be implemented for patients receiving ONS [ 23 ].…”