确定在头颈食管癌患者中进行营养护理的障碍和诱因：国际定量研究

　　为了确定在头颈食管癌患者中进行营养护理的障碍和诱因并解决障碍从而改善营养护理过程，加拿大阿尔伯塔大学、荷兰阿姆斯特丹自由大学、荷兰汉恩应用科学大学、加拿大皇家亚历山德拉医院采用多种方法定性研究设计（包括半结构式调查、专家小组），在为头颈食管癌患者提供护理和治疗的5个欧洲场所选取了29例研究对象。21人专家小组对调查问卷进行了审核，从而确定了需要优先解决的护理障碍。参与者均为医疗服务提供者和研究者，具有头颈食管癌症领域护理的直接经验。

　　结果共确定了5项伴随营养护理出现的障碍和诱因：1、营养干预有益处的证据；2、营养护理的实施（评估、干预以及随访）；3、医疗服务提供者的特点；4、地理因素；5、患者特征。专家小组讨论并确定了2项在营养护理中需要优先解决的问题：1、加强循证依据；2、发展标准化营养护理路径。

　　因此，不同地方关于头颈食管癌症患者的护理问题类似，但伴随的障碍和诱因不同。调查和专家小组成员赞同以下内容将有利于营养护理的改善：1、加强营养护理有益的证据支持，集中解决关于营养护理的具体争议；2、建立明确规定护理角色的最基本数据库从而使营养护理路径标准化。

JPEN J Parenter Enteral Nutr. 2016;40(3):355-66.

Identifying the Barriers and Enablers to Nutrition Care in Head and Neck and Esophageal Cancers: An International Qualitative Study.

Martin L, de van der Schueren MA, Blauwhoff-Buskermolen S, Baracos V, Gramlich L.

University of Alberta, Edmonton, Alberta, Canada; VU University Medical Center, Amsterdam, Netherlands; HAN University of Applied Sciences, Nijmegen, Netherlands; Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada.

BACKGROUND: The goal of this work was to identify barriers and enablers to the implementation of nutrition care in head and neck and esophageal (HNE) cancers and to prioritize barriers to help improve the nutrition care process.

MATERIALS AND METHODS: This study used a multimethod qualitative study design (including semistructured interviews, focus group). Interviews (n = 29) were conducted at 5 European sites providing care and treatment to patients with HNE cancers. A focus group (n = 21) reviewed and corroborated interview findings and identified priorities for nutrition care. Participants were healthcare providers and researchers with direct experience in the field of HNE cancer.

RESULTS: Five themes with accompanying barriers and enablers were identified related to nutrition care: (1) evidence for the benefit of nutrition interventions, (2) implementation of nutrition care processes (assessment, intervention, and follow-up), (3) characteristics of healthcare providers, (4) site factors, and (5) patient characteristics. Focus group discussions identified 2 priorities that must be acted on to improve nutrition care: (1) improve the evidence base and (2) develop standardized nutrition care pathways.

CONCLUSION: Themes related to nutrition care in HNE cancers were similar between sites, but barriers and enablers differed. Interview and focus group participants agreed the following actions will result in improvements in nutrition care: (1) enhance the evidence base to test the benefit of nutrition interventions, with a focus on resolving specific controversies regarding nutrition therapy, and (2) establish a minimum data set with a goal to create standardized nutrition care pathways where roles and responsibilities for care are clearly defined.

KEYWORDS: barriers, enablers; cancer; esophagus; head and neck; nutrition

PMID: 25288589

DOI: 10.1177/0148607114552847