Patient experiences of perioperative nutrition within an Enhanced Recovery After Surgery programme for colorectal surgery: a qualitative study

Abstract

AimNutrition is an important element of the Enhanced Recovery After Surgery (ERAS) programme. Patients have previously indicated that nutrition is a key component of ERAS that requires improvement. Our aim was to explore the perioperative nutrition experiences of colorectal surgical patients to identify barriers and facilitators to the integration of nutrition within ERAS.MethodSixteen individuals undergoing colorectal surgery participated in a semi‐structured interview between postoperative day three and hospital discharge. The topic guide was developed iteratively throughout the study; topics included preoperative counselling, carbohydrate loading, fasting and postoperative nutrition. A constant comparison technique was employed during coding, and an inductive thematic analysis was used. Validity was ensured by double coding a sample of transcripts.ResultsFindings are presented in the context of the following clinical themes: preoperative information, preoperative fasting, carbohydrate loading and nutritional drinks, postoperative diet and discharge. Individuals received too much general information which was repetitive, contradictory and not disease specific; this formed a key barrier affecting nutrition. Other barriers were negative experiences of nutritional drinks, stoma management, nausea and vomiting, and challenges from the hospital environment. Facilitators included interactions with staff, food accessibility and choice, and motivation for discharge.ConclusionThe key barrier to adherence of perioperative nutrition protocols was poor provision of information. Targeted information regarding postoperative diet, stoma management and coping with nausea and vomiting would be beneficial for colorectal surgical patients. Easily accessible food provided by ward staff was considered a facilitator.

Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting

“…When the rationale for the ERAS element was not established, including proof of its effectiveness and safety, adherence was poor for both patients and providers—largely because the recipient was unconvinced or unmotivated to perform the task. Similar qualitative findings have been reported by Short et al, who concluded that the key patient barrier to adherence of perioperative nutrition protocols within a colorectal ERAS program was the poor provision of information. Likewise, a qualitative study by Laur et al identified that hospital staff need a reason, such as perceived or experienced benefits, to change their nutrition care practices.…”

“…That is, coding and theme development are directed by the content of the data—referred to as bottom‐up , in which relevant food and nutrition codes were identified in the data (eg, “white bread”). An inductive, rather than deductive, approach was deemed appropriate for our work given the paucity of published research on the nutrition experiences of patients within an ERAS program setting. The analysis involved the following 6 steps: (1) familiarization with the data, (2) coding the data based on descriptive elements of the data or informed ideas in relation to the research question, (3) identifying potential themes from the codes and collating data under each theme, (4) reviewing and refining the themes (within and across the dataset), (5) defining and naming the themes, (6) contextualizing the analysis in relation to the existing literature and theories.…”

Pre‐operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight‐losing patients with colorectal cancer: single‐blind randomized controlled trial

“…Weight loss in the perioperative period influences people's lives during recovery and post‐operative rehabilitation . Other researchers have highlighted that nutritional information is a priority for individuals and their families . In a recent study of body composition, only 5% of people with colorectal cancer were found to be cachexic based on measurements of fat‐free mass pre‐operatively, suggesting that weight loss is a treatable consequence of colorectal cancer .…”

Nutrition in peri-operative esophageal cancer management

“…Especially patients experiencing postoperative complications feel vulnerable at home and prefer to have ready access to expert clinical advice [118]. For the patient's sense of security and health self-efficacy after (early) discharge, it is important to give patients clear and concise oral and written information on nutritional intake and symptom management at home [119]. Post-discharge home assistance by a nutritional support professional is important.…”