Head and neck cancer patients' experiences of percutaneous endoscopic gastrostomy feeding: a Q-methodology study.

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Authors
Farrell, D
Merrick, Susan
Issue Date
2012-07-01
Journal
Type
Article
Peer-Reviewed Publication
Keywords
Adult
Aged
Enteral nutrition
Gastrostomy
Head and neck cancer
Middle aged
Neck neoplasm
Nutrition
Patient experience
Patient satisfaction
Percutaneous endoscopic gastrostomy
Q-methodology
Qualitative research
Quality of life
Statistical factor analysis
Journal Title
European Journal of Cancer Care
Volume
21
Issue
4
Begin page
493
End page
504
Abstract
Head and neck cancer patients are at high risk of malnutrition and its complications and therefore often undergo non-oral nasogastric or percutaneous endoscopic gastrostomy (PEG) nutrition support. However, there is little evidence that either approach is effective in this group. While one possible explanation for these findings relates to the relationship between artificial tube feeding and poor quality of life, there is little research that examines the patient's subjective experience of nutrition support. This study investigated the experiences of PEG tube feeding in head and neck cancer patients undergoing radical treatment. Conventional Q-methodology was used with 15 head and neck cancer patients, who rank-ordered 36 statements according to the extent to which these reflected their experiences of PEG tube feeding. The sorted statements were factor-analysed case-wise to provide clusters of similar experiences. Three perspectives emerged. Factor 1, labelled ‘Constructive cognitive appraisal’, focused around positive adaptation to, and acceptance of, PEG feeding. Factor 2, labelled ‘Cognitive–affective dissonance’, reflected ambivalence between cognitive acceptance and affective rejection of the PEG tube. Factor 3, labelled ‘Emotion-focused appraisal’, was characterised by tube-focused anxiety and fear. The findings broadly confirm Levanthal et al.'s Self-Regulatory Model of coping and support the need for genuine and individualised patient-centred nutritional care.
Citation
Merrick S, Farrell D. Head and neck cancer patients' experiences of percutaneous endoscopic gastrostomy feeding: a Q-methodology study. Eur J Cancer Care (Engl). 2012 Jul;21(4):493-504. doi: 10.1111/j.1365-2354.2012.01326.x. Epub 2012 Feb 14. PMID: 22329827.