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J B Hopkinson
Dr J B Hopkinson, University of Southampton, Southampton, UK;
How do people with advanced cancer manage their changing eating habits?
Mixed-methods, exploratory case study.
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.
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.
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).
Patients with cancer identified 4 self-action strategies to manage their changing eating habits: taking control, promoting self-worth, relationship work, and distraction.
Hopkinson JB. How people with advanced cancer manage changing eating habits. J Adv Nurs 2007;59:454–62.
Physical, social, and psychological consequences of changing eating habits markedly influence the quality of life of patients with advanced cancer.1 In their study, Hopkinson et al described how changing eating habits influenced these multiple facets of participants’ lives, as well as the self-action strategies used to effectively adjust to resulting challenges. The strategies “taking control,” “promoting self-worth,” “relationship work,” and “distraction” provide little direction for care beyond general supportive nursing care, yet they highlight the importance of situating specific interventions (eg, providing enteral nutrition or empowering self-action) within the social and psychological contexts of patients’ lives. Healthcare professionals have commonly focused on treating the physical symptoms associated with nutrition-related problems in patients with advanced cancer.2 This approach has often failed to alleviate those symptoms or improve quality of life.3 Based on their findings, Hopkinson et al suggest empowering patient self-action through modification of personal and contextual resources as an approach to changing eating habits. Nursing care aimed at enabling modification of resources has the potential to improve quality of life, not only by improving nutrition, but also by building capacity that will improve other facets of patient health.
The authors proposed a theory of self-management for changing eating habits. This theory provides a useful structure for conceptualising important aspects of self-management; however, it requires exploration, testing, and refinement through additional research. Additionally, generation of specific strategies to manage changing eating habits that are congruent with the general strategies identified in this research would provide practical resources that nurses could then draw upon.
Source of funding: Macmillan Cancer Support.
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