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Factors Affecting Healthcare Professionals' Decision-Making Around Parenteral Nutrition in Advanced Cancer: A

Jennifer McCracken¹, Sabrina Bajwah², Clare Shaw^1,3

¹The Royal Marsden NHS Foundation Trust, London, Sutton, UK.

Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association

|February 5, 2025

Abstract

Background:

Many factors beyond clinical guidelines may influence healthcare professionals' (HCPs) decision-making. This systematic review aims to identify the factors that affect HCPs decision-making around parenteral nutrition (PN) in advanced cancer.

Methods:

A literature search was conducted by May 2023 via MEDLINE, Embase, PsycINFO, The Cochrane Library, CINAHL, PubMed, Web of Knowledge and PROSPERO. Fourteen additional papers were identified. Two reviewers independently screened all papers with consensus reached on inclusion. Three reviewers conducted quality appraisal independently. Reference checking and citation tracking were completed for all included papers.

Results:

Of 458 papers identified, 5 papers met the eligibility criteria (3 online surveys, 2 qualitative studies). All papers were European. Papers were published between 2020 and 2023. Six themes were identified as affecting decision-making: clinical indications, quality of life, hope, the multidisciplinary team, barriers to facilitating home PN and the influence of relatives. Performance status was a commonly considered indicator of suitability for home PN. PN is more common for people with advanced cancer and intestinal failure (IF) in the UK. Barriers to providing PN included unclear clinical indication, colleague objections, lack of local expertise and poor communication between HCPs.

Conclusion:

Collaborative working and effective communication are essential between acute services, IF centres and community services to facilitate decision-making around PN in advanced cancer. It is important for HCPs to set realistic expectations. Communication must be sensitive to the patient's values and culture.

Keywords:

advanced cancer decision‐making healthcare professionals parenteral nutrition systematic review

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