Biopsychosocial approach to home enteral nutrition: measure of subjective satisfaction and quality of life.
OBJECTIVE
Home enteral nutrition (HEN) has become a therapeutic option used to prolong considerably the life of those patients who were previously doomed to malnutrition. The recent biopsychosocial suggests to consider the person in a global vision that takes into account not only the physiological but also the psychological and social implications of any treatment we use. In such a vision the wellness of the patients treated in HEN has to be considered in a more general view that considers the effect of the therapy related to quality of life of the person itself. In this study the effects of HEN on the quality of life of the patients and of their primary caregivers was assessed.


METHODS
Twenty patients, 12 males and 8 females, were included in the study. Twelve patients were excluded from the study due to their inability to give informed consent due to a decrease in consciousness and/or cognitive functioning. The 20 patients' mean age was 59.5+14 years with average of 7 years of school education. Twenty-nine caregivers, 25 females and 4 males (mean age = 55.3+/-9 years), were also considered.


RESULTS
The patients' condition was good since none showed symptoms related to the therapy. Of the 20 patients, 14 were hospitalized in the past 12 months and since their clinical conditions were stable they were sent back home, while 4 were hospitalized because of HEN issues. None of the patients showed gastro-enteric complications related to their disease state during the previous 12 months, although 5 patients had constipation, and 2 had temporary diarrhea (spontaneously receded) which reduced the infused caloric intake for 2-3 days from the symptom onset.


CONCLUSIONS
The biopsychosocial approach we used in this study shows that aspects traditionally treated as ''positive'' and desirable by health-care professionals (i.e. the possibility to provide home care) do not have a straightforward correspondence in the emotional sphere of the patient undergoing HEN. On the contrary, in some cases, the subjective perception of the health related quality of life tends to be lower than expected, since the patient endures a treatment which appears to be essentially ineffective in modifying the prognosis of the basal disease.
Paccagnella
A
A
Service of Dietetics and Clinical Nutrition, Department of Medicine, Hospital of Treviso, Treviso, Italy. apaccagnella@ulss.tv.it
Mauri
A
A
Berto
R
R
Falchero
S
S
Baruffi
C
C
Marcon
M L
ML
Faronato
P P
PP
Dal Ben
G
G
Foscolo
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017028:Caregivers / Q000523:psychology; D004750:Enteral Nutrition / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000523:psychology*; D026684:Personal Autonomy; D011581:Psychological Tests; D011788:Quality of Life