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Mealtimes in palliative care contexts: Perspectives of patients, partners, and registered nurses
Marie Cederschiöld University, Department of Health Care Sciences, Palliative Research Centre, PRC.ORCID iD: 0000-0001-6019-4335
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim was to explore patients’, partners’, and registered nurses’ (RNs)experiences of mealtimes in palliative care contexts. Qualitative (studies I, II, IVand V) and quantitative (study IV) study designs were used to explore the experiences of mealtimes in palliative care from various perspectives. Three interview studies (studies I, II, V), a mixed-method systematic review (study III),and a cross-sectional study (study IV), were conducted. The findings showed that patient’s appreciated support that resembled their needs and wishes during hampered eating. Being encouraged to eat could both reduce and induce distress and well-being, social life was affected. Food and eating had existential loading (I, III). The partners described how they tried to support their dying partner by striving to maintain ordinariness around food and mealtimes, as well as finding new ways to support eating (II). RNs highlighted that food and mealtimes in palliative care cause psychosocial distress for patients and their families. Exploration implies that RNs perceptions align with patients’and families’, indicating awareness of the challenges that patients and families face (IV). RNs in palliative care are well prepared to support patients with eating challenges related to physical problems, but might be less prepared to support existential, psychological, and social needs (V).In conclusion, efforts to minimize the distress that patients and families experience in relation to mealtimes in palliative care are required. An area in need of further development is how to support RNs in communicating about food and mealtimes in palliative care to support patients’, partners’, and families’ well-being at the patient’s end-of-life.

Place, publisher, year, edition, pages
Stockholm: Marie Cederschiöld University , 2022. , p. 110
Series
Avhandlingsserie inom området Människan i välfärdssamhället, ISSN 2003-3699 ; 14
Keywords [en]
End-of-life, Family, Food, Mealtimes, Nursing, Nutrition, Palliative care, Partner, Patient perspectives, Registered nurses
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
URN: urn:nbn:se:esh:diva-9425Libris ID: dtkss1lkbhssk0jsISBN: 978-91-985806-3-1 (print)OAI: oai:DiVA.org:esh-9425DiVA, id: diva2:1640320
Public defence
2022-04-08, 09:00
Opponent
Supervisors
Available from: 2022-03-11 Created: 2022-02-24 Last updated: 2023-09-22
List of papers
1. Meanings of eating deficiencies for people admitted to palliative home care
Open this publication in new window or tab >>Meanings of eating deficiencies for people admitted to palliative home care
2015 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 13, no 05, p. 1231-1239Article in journal (Refereed) Published
Abstract [en]

Food and eating are embedded in people's everyday social lives: at home with family members and as part of social interactions. For people with progressive life-limiting conditions, however, eating is often obstructed. The objective of the present study was to explore the meanings of living with eating deficiencies at the end of life among people admitted to specialist palliative home care.

This qualitative inductive study employed an interpretive descriptive approach. A dozen persons, with various diagnoses and eating deficiencies, admitted to two specialist palliative home care units, participated. Data were collected through individual repeated interviews. Data collection and analysis were guided by the interpretive description method.

The results reveal that eating deficiencies among people with progressive life-limiting conditions are existentially loaded markers of impending death. Finding ways to overcome declined food intake and hampered eating enabled our participants to feel able to influence their own well-being and remain hopeful. The results also showed that the eating deficiencies influenced participants' relationships and social interactions in ways that hampered their possibilities of sharing valuable moments together with friends and family members during the final period of life.

Efforts to minimize the distress that people experience in relation to the challenges they face with eating deficiencies are important for well-being at the end of life. Person-centered approaches to acknowledge and support individuals' own ways of experiencing and dealing with their eating deficiencies are recommended that include a multidimensional perspective on food and eating.

Keywords
Eating deficiencies, Existential, Food intake, Interpretive description, Palliative care
National Category
Health Sciences Nursing
Identifiers
urn:nbn:se:esh:diva-4903 (URN)10.1017/S1478951514001199 (DOI)25335943 (PubMedID)
Note

Publication status in dissertation: Published online october 22

Available from: 2015-11-05 Created: 2015-11-05 Last updated: 2023-02-16Bibliographically approved
2. Maintaining ordinariness around food: Partners' experienceies of everyday life with a dying person
Open this publication in new window or tab >>Maintaining ordinariness around food: Partners' experienceies of everyday life with a dying person
Show others...
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2748-2756Article in journal (Refereed) Published
Abstract [en]

Aims and objectives: To explore partners’ experiences of everyday life in caring for a dying person with eating deficiencies at home.

Background: When a dying person receives care at home, eating deficiencies can influence everyday life for family members, who often take responsibility for the provision of food and meals. The literature reveals this to be emotionally stressful. Partners of dying persons are challenged both as caregivers and as partners who will soon lose their life companion. There is a need for studies that provide enhanced understanding about the influence of dying persons’ eating deficiencies on their partners, from the perspective of everyday life.

Design: A qualitative design was chosen to obtain experience-based knowledge of relevance for the clinical context of palliative home care.

Methods: Nine people were purposefully selected and interviewed three–six months after the death of their partner. Data collection and analysis were guided by an interpretive descriptive method.

Results: The partners described experiences of how eating deficiencies brought about changes in the participants’ everyday lives. Two patterns of experiences were identified: the challenge of doing the best for their dying partner around matters involving food and mealtimes, and experiences of striving to maintain ordinariness, including holding on to social values around food, despite experiences of unfamiliarity when the dying partners’ habits were changed.

Conclusion:Living close to a person who has eating deficiencies at the end of life is challenging, both from a caring perspective and for personal well-being.

Relevance to clinical practice: The findings can assist palliative home care teams and other healthcare professionals to give support that goes beyond giving practical advice about food. Initiating talk about the current situation around food and meals at home, by posing questions and opening the way for conversations, is suggested.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keywords
Eating, Everyday life, Family, Food, Interview, Palliative care, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-4149 (URN)10.1111/jocn.12518 (DOI)24372727 (PubMedID)
Note

This research was funded by the Erling-Persson Family Foundation and Ersta Sköndal University College.

Available from: 2014-10-23 Created: 2014-10-23 Last updated: 2024-02-23Bibliographically approved
3. Experiences of food and mealtime from the perspective of patients with chronic life-limiting disease: a mixed-method systematic review
Open this publication in new window or tab >>Experiences of food and mealtime from the perspective of patients with chronic life-limiting disease: a mixed-method systematic review
2021 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 77, no 11, p. 4400-4413Article, review/survey (Refereed) Published
Abstract [en]

Aim: To describe and synthesise experiences of food and mealtimes from the perspective of patients with chronic life-limiting disease.

Design: A mixed-method systematic review.

Data sources: The databases Academic Search Complete, CINAHL, Nursing and Allied Health Database, PsycINFO, PubMed, Soc Index and Web of Science Core Collection were searched (January 2000 to March 2019).

Review methods: Out of 3151 identified articles, 24 were included for appraisal and synthesis, using a data based convergent design.

Results: Four themes were derived: 'understanding hampered eating-perhaps it is best to let nature run its course'; 'food and meals evoke distress-reducing joy, testing interim ways'; 'struggling with food and meals-eating to please others and to postpone death'; and 'food and meals as caring and love-flanked by social disconnecting'.

Conclusion: For patients with chronic life-limiting disease, food entailed potential to remain healthy, improve well-being and prolong life. Meanwhile, eating difficulties were experienced as fundamentally affecting social life and interactions; consequently, joy around food and meals was lost.

Keywords
Chronic disease, Eating problems, End-of-life, Nursing, Nutrition, Patient perspectives, Systematic review
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-8904 (URN)10.1111/jan.14927 (DOI)000661963400001 ()34133759 (PubMedID)
Available from: 2021-06-03 Created: 2021-06-03 Last updated: 2023-11-21Bibliographically approved
4. Registered nurses’ perceptions of food and mealtimes in palliative care: a cross-sectional study
Open this publication in new window or tab >>Registered nurses’ perceptions of food and mealtimes in palliative care: a cross-sectional study
Show others...
(English)In: Article in journal (Refereed) Submitted
National Category
Nursing
Research subject
The Individual in the Welfare Society, Palliative Care
Identifiers
urn:nbn:se:esh:diva-9424 (URN)
Available from: 2022-02-24 Created: 2022-02-24 Last updated: 2023-02-16Bibliographically approved
5. Caring for patients with eating deficiencies in palliative care—Registered nurses' experiences: A qualitative study
Open this publication in new window or tab >>Caring for patients with eating deficiencies in palliative care—Registered nurses' experiences: A qualitative study
2022 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 31, no 21-22, p. 3165-3177Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: The aim was to explore RNs' experiences of caring for patients with eating deficiencies in palliative care.

BACKGROUND: Food and mealtimes are fundamental aspects for wellbeing and social interactions. The worldwide trajectory of ageing populations may result in increased need for palliative care. Everyday life with chronic life limiting illness and eating deficiencies is challenging for patients and families. RNs are key care providers at end-of-life.

DESIGN: A qualitative study with an inductive approach was used.

METHODS: Nineteen experienced RNs in palliative care were interviewed through telephone; interviews were audio recorded and transcribed verbatim. Inductive qualitative content analysis was performed, and the COREQ checklist was used to guide proceedings.

RESULTS: The overarching theme, Supporting persons with eating deficiencies in-between palliative care and end-of-life care, is represented by three sub-themes: Easy to stick with doing, Just being, without doing, is hard and Letting go. Near end-of-life, eating symbolized social belonging and quality of life for RNs, whereas for patients and families, eating symbolized life. RNs tried practical solutions, however, not always according to patients' and families' preferences.

CONCLUSIONS: RNs were well prepared to tackle physical inconveniences and provide support, however, less prepared to encounter existential, psychological and social issues in relation to eating deficiencies. Although RNs stated that human beings stop eating when they are about to die, letting nature run its' course and facilitating patients' transition to end-of-life care was challenging.

RELEVANCE TO CLINICAL PRACTICE: Food and mealtimes represent fundamental aspects of human life and denote central parts in RNs clinical practice in palliative care. The findings can inspire development of a comprehensive palliative care approach to support patients and families. Structured reflection in relation to clinical practice may support and encourage RNs, caring for patients with eating deficiencies, in mastering both doing and being.

Keywords
Caring, Eating problems, End-of-life, Families, Mealtime, Nursing, Nutrition, Palliative care, Patients
National Category
Nursing
Identifiers
urn:nbn:se:esh:diva-9295 (URN)10.1111/jocn.16149 (DOI)000723896300001 ()34850477 (PubMedID)
Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2023-02-16Bibliographically approved

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