Decision Making for Enteral Nutrition in Adult Patients with Dysphagia – A Guide for Health Care Professionals

Abstract

Optimal hydration and nutrition is required to meet the body's daily nutritional requirements. Patients with dysphagia may be unable to attain these minimum nutritional requirements with oral intake and require enteral nutrition [2-9]. These patients include those who are unable to swallow due to neurological damage or degeneration [4, 10-15], or those who have structural abnormalities that make oral nutrition impossible, as in the case of patients with advanced stage head and neck cancer or oesophageal cancer [16-18].

Perceived needs of patients and family caregivers regarding home-based enteral nutritional therapy in South Africa: A qualitative study

“…Again, patients and/or family caregivers told us that they were informed or involved in decision making regarding the method of nutritional therapy. This was in line with what Kenny and Singh [36] argue; that decision making about enteral nutrition is often intricate and requires the consideration of a number of aspects, including respecting the wishes of the patient and their families, not only the medical need for the intervention. These authors further add that provision of artificial nutritional therapy can be an emotional topic, even for health care professionals, which sometimes makes them uncomfortable and unsure of what recommendations to make [36].…”

“…Again, in this study, one participant (P4) expressed the need for home visits, professional advice on how to handle the relative with stroke-they could not even get her out of bed and were psychologically drained. This seems to be closely related to what [36], Chen, Lai [45] reiterated, namely that patients with more severe symptoms and caregivers with less social support from family were more likely to have overall unmet supportive care needs. They recommended that these caregivers should be assessed on the discharge of their relative with regard to provision of psychological counselling and availability of a support group.…”

“…Although the findings did not come as a surprise, as KwaZulu-Natal is described as one of South Africa's poorest and most densely populated provinces [37], it is a concern and measures have to be taken towards meeting the patients' needs. [36], Pillay and Skordis-Worrall [38] affirm the financial decline in public policy globally, meaning that South Africa is not an exception. This was supported by Holst and Rasmussen [3] who stated that the transition between hospital and home leaves patients and their relatives with unmet financial support needs.…”

“…Patient inability to pay for the transport costs of clinic visits has been identified as a leading cause of loss to follow-up and treatment default [41]. Kenny and Singh [36] and Wong, Goh, Banks, et al [42] mentioned something different from other authors, pointing out that there are indirect costs that include taking time off work by family caregivers, as well as other intangible patient outcomes that need to be considered, besides the direct costs of HEN.…”

“…According to Boland, Maher [14], psychological distress may sometimes be accompanied by reluctance among HEN patients to leave their homes. Reluctance to go out of the home environment may sometimes be combined with reluctance to express these psychological needs, which may sometimes be the reason for psychological and emotional burden not being identified or reported as low in some communities [36,40]. Bjuresäter [55] associate increased psychological needs with lacking preparation before discharge and lacking support at home causing insecurity and uncertainty.…”