Patients with advanced cancer used 4 self-action strategies to manage eating-related problemsCommentary

Evidence Based Nursingebn.bmj.com Evid Based Nurs 2008;11:61 doi:10.1136/ebn.11.2.61 * Qualitative Patients with advanced cancer used 4 self-action strategies to manage eating-related problems Next Section J B Hopkinson Dr J B Hopkinson, University of Southampton, Southampton, UK; jbh@soton.ac.uk Previous SectionNext Section QUESTION How do people with advanced cancer manage their changing eating habits? Previous SectionNext Section DESIGN Mixed-methods, exploratory case study. Previous SectionNext Section SETTING UK. Previous SectionNext Section PARTICIPANTS A purposeful sample of 30 patients >18 years of age (age range 43–85 y, 53% men) who had advanced cancer and were receiving palliative home care. None were receiving active treatment or artificial feeding at the time of the interview. Previous SectionNext Section METHODS In individual, audiotaped, semi-structured interviews (20–60 min), participants were asked to talk about their experiences with changing eating habits and what had helped them to live with those changes. Data collection and analysis were informed by hermeneutic phenomenology. Data were analysed using a mixed strategy for cross-case analysis, which included content and thematic approaches. Previous SectionNext Section MAIN FINDINGS Participants commonly experienced changes in eating habits. Eating became a chore, and changes in smell, taste, and texture of food affected the desire or ability to eat. The proposed theory of self-management of changing eating behaviours included self-actions (ie, those initiated by patients rather than others), which could be facilitated by changing individual and contextual factors. Most participants felt they had some influence over changing eating habits and could minimise negative outcomes through self-action (eg, explaining to others about their different needs) (individual factors). An example of contextual influences was the perception that other people and circumstances could promote (eg, having a variety of foods available as needed) or block (eg, providing too much food at a sitting) self-action. Participants described 141 self-actions, which were components of 4 self-action strategies used alone or in combination to self-manage changing eating habits and associated negative emotions such as anger and guilt. (1) Taking control. Patients generally experienced the loss of desire or ability to eat foods previously enjoyed as a loss of control or consequence of a lack of willpower. Some took action to retain or regain control (eg, having something nutritious available for when they felt hungry). (2) Promoting self-worth. Patients perceived foods as good (eg, fruit) or bad (eg, cakes) for health and survival; finding foods that were both good and tolerable could be difficult. Some patients overcame guilt or shame about the foods they could not eat by focusing on the value of foods they did eat (eg, eating well yesterday as compensation for inability to eat today) or the value of changes in eating habits that affected other family members (eg, resulting in desired weight loss for others). (3) Relationship work. Changing eating habits could lead to family tensions when patients could not eat meals prepared by family members. This often led to patients feeling guilty and eating just to please the carer. However, one patient described reinforcing her relationship with her husband by teaching him to cook and sharing her cooking experiences with him. (4) Distraction. Patients commonly reported using humour as a distraction, which allowed them to feel positive and avoid thinking about changing eating habits. Some recalled and celebrated past achievements that were positively related to eating (eg, effect of healthy eating on ability to perform physical activities). Previous SectionNext Section CONCLUSION Patients with cancer identified 4 self-action strategies to manage their changing eating habits: taking control, promoting self-worth, relationship work, and distraction.

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