Impact of infusion frequency on quality of life in patients receiving home parenteral nutrition

Abstract

Home parenteral nutrition (HPN) may be needed as a long-term therapy for patients with chronic intestinal failure whose clinical condition does not allow complete weaning of the parenteral nutrition (PN) solution. HPN is a time-consuming and clinically complex therapy and can negatively affect quality of life (QOL). The level of dependency on HPN, specifically, infusion frequency, has been proposed as a factor that may have an effect on QOL in patients receiving HPN. The primary aim of this qualitative review is to identify the impact of HPN frequency (days per week of HPN infusion) on QOL measurements in adult patients receiving HPN. A comprehensive literature search was completed in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Primary clinical research studies were included if they were conducted in adult patients receiving HPN and included the assessment of the associations between the frequency of HPN infusion and QOL measurements. Six articles ultimately met the criteria for this review. There was variability among the studies, including use of different tools to measure QOL. However, all six studies suggest that a reduction in HPN frequency may be associated with an improvement in QOL.Whenever patients' clinical situation allows, a reduction in HPN frequency should be considered to improve QOL in patients receiving HPN.

Factors associated with strong opioid use for noncancer pain in patients with chronic intestinal failure

“…Clearly these two factors are connected, as demonstrated recently by Samuel et al that <5 HPN infusions/week was significantly associated with returning to work after HPN commencement 34 . A recent qualitative review also concluded that improvement in quality of life is associated with a reduction in HPN frequency and that the frequency reduction is highly prioritized among HPN‐dependent patients 37 …”

“…34 A recent qualitative review also concluded that improvement in quality of life is associated with a reduction in HPN frequency and that the frequency reduction is highly prioritized among HPN-dependent patients. 37 Further work is now required to evaluate the reason for unemployment in patients requiring opioids; whether this relates to the number of nights of PN, pain, side effects of opioids or other disease related factors, or-perhaps most likely-a combination of all of these issues.…”

“… 34 A recent qualitative review also concluded that improvement in quality of life is associated with a reduction in HPN frequency and that the frequency reduction is highly prioritized among HPN‐dependent patients. 37 …”

Epidemiology, survival, costs, and quality of life in adults with short bowel syndrome

“…Some individuals were unaware they could have flexibility with their infusion schedules, underscoring the importance of having clinician‐patient conversations about goals, priorities, and personal preferences of HPN therapy. When desired by a patient and the clinical situation allows, a reduction in PN frequency should be considered to improve QOL in patients receiving HPN 50 …”

“…When desired by a patient and the clinical situation allows, a reduction in PN frequency should be considered to improve QOL in patients receiving HPN. 50 The use of patient-reported outcomes (PROs) is a clinically useful approach to monitor progression of disease or response to treatment as well as to improve clinician-patient communication and expand the role of shared or informed decision making. 51 HPN-dependent adults desire a holistic approach to their healthcare with emotional support provided in addition to medical care and nutrition assessment.…”