Royal Prince Alfred Hospital, Sydney, NSW, Australia.
University of Sydney, Sydney, NSW, Australia.
Support Care Cancer. 2019 May;27(5):1853-1860. doi: 10.1007/s00520-018-4445-1. Epub 2018 Sep 5.
Compliance with oral nutrition support (ONS) is poorly reported in the literature. Many factors influence compliance, which could mask the true benefits of preoperative ONS. Surgical oncology patients, including pelvic exenteration patients, are often requested by healthcare workers to consume nutrition supplements before surgery. Exploration of barriers and enablers to compliance with nutrition supplements is needed to improve patient compliance and understand the real impact of preoperative ONS.
A qualitative study using semi-structured interviews was performed to investigate enablers and barriers to preoperative nutrition supplement compliance. Twenty participants who had been asked to consume 15 nutrition supplements, either immunonutrition or standard polymeric supplements, were interviewed. Inductive thematic analysis was used to determine major themes associated with compliance.
Twelve out of 20 participants were not compliant with recommended dosing. Well-nourished participants were more compliant than malnourished participants. Major themes associated with compliance were flavour, volume, texture, impact on dietary intake and motivation to consume supplements. Flavour differed between the two groups, negatively impacting compliance in the immunonutrition group. Volume, texture and impact on dietary intake also negatively impacted compliance whereas motivation positively impacted compliance.
To overcome barriers and enforce enablers with nutrition supplement compliance, it is essential healthcare workers implement individualised interventions, taking into account nutritional status. A range of flavours, minimal volume and low viscosity supplements should be provided to address individual preference and minimise poor compliance. Better-targeted education and regular motivation are needed to improve compliance.
文献中对口服营养支持（ONS）的依从性报道较差。许多因素会影响依从性，这可能掩盖了术前 ONS 的真正益处。外科肿瘤患者，包括盆腔切除术患者，经常被医护人员要求在手术前食用营养补充剂。需要探索遵守营养补充剂的障碍和促进因素，以提高患者的依从性并了解术前 ONS 的实际影响。
采用半结构式访谈进行定性研究，以调查术前营养补充剂依从性的促进因素和障碍。对 20 名参与者进行了访谈，他们被要求食用 15 种营养补充剂，要么是免疫营养剂，要么是标准聚合物补充剂。采用归纳主题分析来确定与依从性相关的主要主题。
20 名参与者中有 12 名没有按照建议的剂量服用。营养良好的参与者比营养不良的参与者更遵守规定。与依从性相关的主要主题是口味、体积、质地、对饮食摄入的影响和服用补充剂的动机。两组之间的口味不同，对免疫营养组的依从性产生负面影响。体积、质地和对饮食摄入的影响也对依从性产生负面影响，而动机则对依从性产生积极影响。
为了克服营养补充剂依从性的障碍并加强促进因素，医护人员必须实施个体化干预措施，同时考虑到营养状况。应提供各种口味、最小体积和低粘度的补充剂，以满足个人喜好并最大程度减少依从性差的情况。需要更好的针对性教育和定期的激励来提高依从性。
