Head and neck cancer patients' experiences of percutaneous endoscopic gastrostomy feeding: a Q-methodology study

Abstract

Head and neck cancer patients are at high risk of malnutrition and its complications and therefore often undergo non-oral nasogastric or percutaneous endoscopic gastrostomy (PEG) nutrition support. However, there is little evidence that either approach is effective in this group. While one possible explanation for these findings relates to the relationship between artificial tube feeding and poor quality of life, there is little research that examines the patient's subjective experience of nutrition support. This study investigated the experiences of PEG tube feeding in head and neck cancer patients undergoing radical treatment. Conventional Q-methodology was used with 15 head and neck cancer patients, who rank-ordered 36 statements according to the extent to which these reflected their experiences of PEG tube feeding. The sorted statements were factor-analysed case-wise to provide clusters of similar experiences. Three perspectives emerged. Factor 1, labelled 'Constructive cognitive appraisal', focused around positive adaptation to, and acceptance of, PEG feeding. Factor 2, labelled 'Cognitive-affective dissonance', reflected ambivalence between cognitive acceptance and affective rejection of the PEG tube. Factor 3, labelled 'Emotion-focused appraisal', was characterised by tube-focused anxiety and fear. The findings broadly confirm Levanthal et al.'s Self-Regulatory Model of coping and support the need for genuine and individualised patient-centred nutritional care.

A Course of Innovations in Wood Processing Industry within the Forestry-Wood Chain in Slovakia: A Q Methodology Study to Identify Future Orientation in the Sector

“…The procedure of Q sorting is the technical means whereby data are obtained for factoring [54]. As an independent research tool it was adopted in many scientific fields, for example in market research, politology, in the field of psychology or environmental protection [55]. Several studies using Q-methodology were published endoscopic gastrostomy feeding [56], psychosis [57], political science [54], utilization of public land [58] or in understanding participant's perspective in national forest management [59], for mapping stakeholder perceptions in participatory forest management [60] or incorporating values into community-scale sustainable forest management plans [61].…”

Beliefs, identities and educational practice: a Q methodology study of general practice supervisors

“…Q methodology has been used to study viewpoints in a variety of fields including medical education. [22][23][24][25][26][27] It combines the strengths of qualitative and quantitative methodologies by using quantitative analyses to support qualitative interpretation of viewpoints. 28 The first step in Q methodology is to develop a list of statements which should adequately represent the universe of beliefs about the topic at hand.…”

Optimising nutrition support in patients with head and neck cancer

“…The patient experience with feeding tubes may also account for factors relating to patient adherence and four recent qualitative studies have investigated this. Merrick & Farrell (2012) reported three main themes emerged from their study on gastrostomy tube experience; positive adaptation to acceptance of tube feeding (n=9); ambivalence between acceptance and rejection of the tube (n=4); and anxiety and fear of the tube (n=2) (Merrick & Farrell, 2012). The positive cognitive approach towards the tube in the first group may have been a contributing factor to less weight loss (6.5% vs 10-15%).…”

“…Of note, as the feeding tube is most likely in-situ to improve a patient's nutritional status, malnutrition may actually be a confounding factor of reduced QOL (Ravasco et al, 2004). However, patients are generally keen to have their tube removed as soon as possible, with a recent qualitative study suggesting that patients appear to equate tube removal with a positive transitional stage in the recovery process towards cure from their cancer (Merrick & Farrell, 2012). Thus it is important for patients (and carers) to understand the potential impacts of tube feeding upon QOL and be provided with appropriate supports and counselling to develop coping strategies to adapt to the impact of tube feeding upon their personal lives (Brotherton, Abbott, & Aggett, 2006).…”

“…This observation was supported by recent studies in the literature where Salas et al (2009) reported a negative physical effect of the gastrostomy just after the beginning of treatment, but also a positive mental effect over time as patients became used to the tube (Salas et al, 2009). Merrick& Farrell (2012) also recently explored patient experiences with a gastrostomy tube through a qualitative study design, and three themes were found (Merrick & Farrell, 2012). The majority of patients demonstrated "constructive cognitive appraisal" whereby they positively adapted to the tube and accepted tube feeding.…”