Abstract
Purpose
Clear recommendations on how to guide patients with cancer on home parenteral nutrition (HPN) are lacking as the use of HPN in this population remains a controversial issue. Therefore, the aims of this study were to rank treatment recommendations and main outcome indicators to ensure high-quality care and to indicate differences in care concerning benign versus malignant patients.
Methods
Treatment recommendations, identified from published guidelines, were used as a starting point for a two-round Delphi approach. Comments and additional interventions proposed in the first round were reevaluated in the second round. Ordinal logistic regression with SPSS 2.0 was used to identify differences in care concerning benign versus malignant patients.
Results
Twenty-seven experts from five European countries completed two Delphi rounds. After the second Delphi round, the top three most important outcome indicators were (1) quality of life (QoL), (2) incidence of hospital readmission and (3) incidence of catheter-related infections. Forty-two interventions were considered as important for quality of care (28/42 based on published guidelines; 14/42 newly suggested by Delphi panel). The topics ‘Liver disease’ and ‘Metabolic bone disease’ were considered less important for cancer patients, together with use of infusion pumps (p = 0.004) and monitoring of vitamins and trace elements (p = 0.000). Monitoring of QoL is considered more important for cancer patients (p = 0.03).
Conclusion
Using a two-round Delphi approach, we developed a minimal set of 42 interventions that may be used to determine quality of care in HPN patients with malignancies. This set of interventions differs from a similar set developed for benign patients.
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Acknowledgements
Ph. Mira Dreesen has an unconditional educational grant from the company Baxter Belgium. We would also like to thank the members of the expert panel for their cooperation, interest and expertise in this domain.
Conflict of interest statement
No authors have financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Only Mira Dreesen has unconditional educational grant from the Company Baxter Belgium. This company is not involved in the study design, in the collection, analysis and interpretation of the data, in the writing of the manuscript and in the decision to submit the manuscript for publication.
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Dreesen, M., Foulon, V., Hiele, M. et al. Quality of care for cancer patients on home parenteral nutrition: development of key interventions and outcome indicators using a two-round Delphi approach. Support Care Cancer 21, 1373–1381 (2013). https://doi.org/10.1007/s00520-012-1679-1
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DOI: https://doi.org/10.1007/s00520-012-1679-1