Dunleavy Lisa, Al-Mukhtar Ahmed, Halliday Vanessa
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Clin Nutr ESPEN. 2018 Aug;26:97-103. doi: 10.1016/j.clnesp.2018.04.007. Epub 2018 May 4.
For those diagnosed with pancreatic cancer, ill-addressed pancreatic exocrine insufficiency (PEI) following surgery can result in malnutrition related complications that may impact on predict mortality and morbidity. The use of pancreatic enzyme replacement therapy (PERT) is recommended and often demands a degree of patient self-management. Understanding more about how this treatment is managed is fundamental to optimising care.
This study aimed to explore patient self-management of PERT following surgery for pancreatic cancer.
Semi-structured interviews were conducted with nine participants. Eligible participants included adult patients who had undergone surgery for a malignancy in the pancreatic region and were prescribed PERT post-operatively. Inductive thematic analysis was used to analyse our findings.
Data analysis revealed three overarching themes; the role of professional support, factors influencing decisions to use PERT in symptom management and the challenges of socializing. The difficulties negotiated by participants were considerable as they struggled with the complexities of PERT. Symptom management and subsequently reported physical repercussions and undesirable social implications were problematic. Professional support was largely inconsistent and relinquished prematurely following discharge. Consequently, this impacted on how PERT was self-managed.
Enabling patients to appropriately self-manage PERT may lessen the post-treatment burden. Our findings suggest that support should continue throughout the recovery phase and should address the patient's 'self-management journey'. Intervention by healthcare professionals, such as a specialist dietitian is likely to be beneficial. Furthermore there are focal issues, primarily explicit education and appropriately timed information that require consideration by those developing and delivering services.
对于那些被诊断为胰腺癌的患者，术后胰腺外分泌功能不全（PEI）处理不当会导致与营养不良相关的并发症，这可能会影响死亡率和发病率的预测。推荐使用胰酶替代疗法（PERT），且通常需要患者进行一定程度的自我管理。更多地了解这种治疗方法的管理方式对于优化护理至关重要。
本研究旨在探讨胰腺癌手术后患者对PERT的自我管理情况。
对9名参与者进行了半结构化访谈。符合条件的参与者包括在胰腺区域进行过恶性肿瘤手术且术后被开具PERT的成年患者。采用归纳主题分析法对研究结果进行分析。
数据分析揭示了三个总体主题；专业支持的作用、影响在症状管理中使用PERT的决策因素以及社交方面的挑战。参与者所面临的困难相当大，因为他们在应对PERT的复杂性时遇到了困难。症状管理以及随后报告的身体影响和不良社会影响都存在问题。专业支持在很大程度上不一致，出院后过早停止。因此，这影响了PERT的自我管理方式。
使患者能够适当地自我管理PERT可能会减轻治疗后的负担。我们的研究结果表明，在整个康复阶段都应持续提供支持，并应关注患者的“自我管理过程”。医疗保健专业人员的干预，如专科营养师，可能会有所帮助。此外，还有一些重点问题，主要是明确的教育和适时的信息，需要服务的开发者和提供者加以考虑。
