Emily Hazzard1,2, Karen Walton2,3, Anne-Therese McMahon2, Marianna Milosavljevic1, Linda Tapsell2,3. 1. Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. 2. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. 3. Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
Abstract
BACKGROUND: Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. METHODS: Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). CONCLUSION: Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.
BACKGROUND: Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. METHODS: Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). CONCLUSION: Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.