Psychology, Nanyang Technological University, Singapore.
Health Services and Systems Research, Duke-NUS Medical School, Singapore.
BMJ Open. 2021 Apr 13;11(4):e038914. doi: 10.1136/bmjopen-2020-038914.
With 'eating' posited as Singapore's domestic pastime, food experiences for Singaporeans constitute national, social, ethnic and personal identities. However, though they form significant parts of Singaporean existence across the lifespan, studies and observations about food experiences for individuals at the end of life remain noticeably absent. Extant literature continues to focus on nutritional practice during illness and the active dying process, forgoing the rich lived experiences of food in the lives of patients and their families. The current work sought to qualitatively extricate through a constructivist phenomenological approach, the 'food voices' of Singaporean palliative care patients and their families. It also simultaneously aimed to assess the role of food in bolstering their subjective feelings of dignity and identity, while also considering resultant clinical implications.
Homes of patients within the Singaporean palliative care setting.
A subset of qualitative data (n=25) in the form of dyadic interviews with terminally ill patients and a family caregiver was generated from a larger family dignity intervention study that explored the experience of living and dying among Asian palliative care patients and their families.
Framework analysis with both inductive and deductive approaches informed by the a priori domain of food resulted in the generation of four major themes, each with three subthemes. These were organised into the Food for Life and Palliation model. They include: (1) feeding identity and familial bonds, (2) liminal subsistence in illness transition, (3) food becoming lineage, and (4) compassionate nourishment.
Clinical implications are considered; including food-focused interventions that enhance dignity, promote meaning-making and facilitate legacy construction. Developmental suggestions are also directed at industry partners producing end-of-life nutrition products.
“吃”被认为是新加坡的一种国内消遣方式，因此，新加坡人的饮食体验构成了他们的国家、社会、民族和个人身份。然而，尽管饮食体验在新加坡人的一生各个阶段都占有重要地位，但针对生命末期个人饮食体验的研究和观察仍然明显缺失。现有的文献继续关注疾病期间的营养实践和积极的临终过程，而忽略了患者及其家人在生活中丰富的饮食体验。本研究旨在通过建构主义现象学方法，从定性的角度揭示新加坡姑息治疗患者及其家人的“饮食声音”。同时，它还旨在评估食物在增强他们的尊严和身份感方面的作用，同时考虑到由此产生的临床意义。
新加坡姑息治疗环境中的患者家中。
从一项更大的家庭尊严干预研究中产生了一组定性数据（n=25），形式为终末期患者和一名家庭照顾者的二元访谈。该研究探索了亚洲姑息治疗患者及其家庭的生活和死亡体验。
通过预先确定的食物领域的归纳和演绎方法进行的框架分析，产生了四个主要主题，每个主题都有三个子主题。这些主题被组织成“生命与姑息治疗的食物”模型。它们包括：（1）喂养身份和家庭纽带，（2）疾病过渡中的边缘生存，（3）食物成为家族传承，以及（4）富有同情心的滋养。
考虑了临床意义，包括以食物为重点的干预措施，这些干预措施可以增强尊严、促进意义建构和促进遗产建设。还向生产临终营养产品的行业合作伙伴提出了发展建议。
