title: The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families.
abstract: OBJECTIVE
  Little is known about the perspectives that patients with advanced cancer and their family members have concerning nutritional problems and nutritional support. The aim of this study was to investigate their experiences of the nutritional situation prior to introduction of home parenteral nutrition (HPN) in order to understand factors contributing to the decision to accept HPN.
  
  
  METHODS
  Semi-structured interviews were conducted with 13 patients with advanced cancer who had received HPN and 11 family members. The constant comparative method was used for data analysis.
  
  
  RESULTS
  Patients and family members described the nutritional situation prior to HPN as a source of worry and often desperation. Patients reported wanting and trying to eat, but being unable to do so. Family members experienced powerlessness and frustration, as they could not enable the patient to eat. A lack of attention to nutritional problems by the hospital staff was described. The offer of HPN came when patients and family no longer felt able to solve the nutritional problems within the family.
  
  
  CONCLUSIONS
  The desperate and chaotic nutritional situation in the family led to willingness to accept HPN. Because of the severity of the problems, HPN was viewed as a positive alternative.
authors.affiliation: Division of Surgery, Center for Surgical Sciences, Karolinska Institutet, Stockholm, Sweden. ylva.orrevall@cfss.ki.se
authors.forename: Ylva
authors.initials: Y
authors.lastname: Orrevall
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: M K Margery K
authors.initials: MK
authors.lastname: Herrington
authors.forename: Johan
authors.initials: J
authors.lastname: Permert
mesh_terms: D000368:Aged; D001293:Attitude to Death; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D016331:Parenteral Nutrition, Home / Q000379:methods / Q000523:psychology; D011788:Quality of Life; D019452:Terminally Ill