Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

10.34172/jqr.2024.26

Abstract

Background: The present study aimed to explore the nutritional challenges of hospitalized cancer patients from the viewpoint of healthcare professionals.
Methods: This qualitative content analysis study was conducted from June 2021 to February 2022 on a sample of nutritionists (researchers and faculty members), dietitians, nurses, and oncologists in various healthcare settings such as hospitals, private/public clinics, research centers, and universities in Tehran, Iran. Data were collected through semi-structured in-depth interviews, which continued until data saturation was achieved with a total of 16 participants. Data were analyzed using deductive-inductive content analysis to explore predefined deductive concepts from previous studies and inductive concepts from the interviews.
Results: After analyzing data via open coding, eliminating similar codes, and classifying the codes with similar concepts, six main themes emerged. The identified themes included problems related to the nature of the disease and complications of treatment, carelessness about principles of cancer care, lack of awareness and education in patients and medical staff, executive shortcomings, planning and policy-making, and financial and support barriers.
Conclusion: Nutritional problems of cancer patients are multidimensional and rooted in diverse challenging issues including problems related to the nature of the disease and treatment, financial barriers, manpower shortages, lack of awareness among patients and healthcare providers, shortcomings related to the healthcare management and executive issues, lack of inter-organizational cooperation, and the significant negative impact of severe economic sanctions. Solving these problems needs funding from the government, interdepartmental cooperation between medical universities, healthcare centers, and hospitals, comprehensive and evidence-based healthcare management at the national level, and international collaborations.

Keywords

  1. Arends J. Malnutrition in cancer patients: causes, consequences and treatment options. Eur J Surg Oncol. 2024;50(5):107074. doi: 10.1016/j.ejso.2023.107074.
  2. Bianchini C, Bonomo P, Bossi P, Caccialanza R, Fabi A. Bridging gaps in cancer cachexia care: current insights and future perspectives. Cancer Treat Rev. 2024;125:102717. doi: 10.1016/j.ctrv.2024.102717.
  3. Caccialanza R, Cereda E, Pinto C, Cotogni P, Farina G, Gavazzi C, et al. Awareness and consideration of malnutrition among oncologists: insights from an exploratory survey. Nutrition. 2016;32(9):1028-32. doi: 10.1016/j.nut.2016.02.005.
  4. Wang T, Molassiotis A, Chung BP, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(1):96. doi: 10.1186/s12904-018-0346-9.
  5. Zhang X, Wu Z, Zhao H, Li C, Wu J, Dai G. Conclusiveness of the Cochrane reviews in palliative and supportive care for cancer. Am J Hosp Palliat Care. 2017;34(1):53-6. doi: 10.1177/1049909115605058.
  6. Zhang X, Zhou Y, Deng T, Yuan X, Xiong J, Lin Y, et al. Where are we and where to go for supportive cancer care in China? A national survey of patients and healthcare providers. Res Sq [Preprint]. March 25, 2021. Available from: https://www. researchsquare.com/article/rs-263902/v1.
  7. Kruk ME, Gage AD, Arsenault C, Jordan K, Leslie HH, Roder- DeWan S, et al. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196-252. doi: 10.1016/s2214- 109x(18)30386-3.
  8. Furness K, Huggins C, Croagh D, Haines T. Exploring the attitudes of health professionals providing care to patients undergoing treatment for upper gastrointestinal cancers to different models of nutrition care delivery: a qualitative investigation. Nutrients. 2021;13(3):1020. doi: 10.3390/ nu13031020.
  9. Smith KC, Coa KI, Klassen AC. A qualitative study of dietary discussions as an emerging task for cancer clinicians. SAGE Open Med. 2016;4:2050312116665935. doi: 10.1177/2050312116665935.
  10. Johnston EA, van der Pols JC, Ekberg S. Needs, preferences, and experiences of adult cancer survivors in accessing dietary information post-treatment: a scoping review. Eur J Cancer Care (Engl). 2021;30(2):e13381. doi: 10.1111/ecc.13381.
  11. Jabbari M, Khoubbin Khoshnazar T, Haghighian-Roudsari A, Taghizadeh-Hesary F, Milani-Bonab A. The viewpoints of hospitalized patients with cancer regarding their nutritional challenges in hospital: a phenomenological study. J Nutr Food Secur. 2022;7(4):424-36. doi: 10.18502/jnfs.v7i4.11052.
  12. Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. SAGE Publications; 2014.
  13. Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation 1986;1986(30):73-84. doi: 10.1002/ ev.1427.
  14. Godlee F, Jefferson T. Peer Review in Health Sciences. London: BMJ Books; 2003.
  15. Cass AR, Charlton KE. Prevalence of hospital-acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: a systematic review of the evidence. J Hum Nutr Diet. 2022;35(6):1043-58. doi: 10.1111/jhn.13009.
  16. Trinca V, Duizer L, Keller H. Putting quality food on the tray: factors associated with patients’ perceptions of the hospital food experience. J Hum Nutr Diet. 2022;35(1):81-93. doi: 10.1111/jhn.12929.
  17. Moran A, Lederer A, Johnson Curtis C. Use of nutrition standards to improve nutritional quality of hospital patient meals: findings from New York City’s Healthy Hospital Food Initiative. J Acad Nutr Diet. 2015;115(11):1847-54. doi: 10.1016/j.jand.2015.07.017.
  18. Muscaritoli M, Corsaro E, Molfino A. Awareness of cancer-related malnutrition and its management: analysis of the results from a survey conducted among medical oncologists. Front Oncol. 2021;11:682999. doi: 10.3389/fonc.2021.682999.
  19. Wang T, Molassiotis A, Chung BP, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliat Care. 2018;17(1):96. doi: 10.1186/s12904-018-0346-9.
  20. Chua GP, Pang GS, Yee AC, Neo PS, Zhou S, Lim C, et al. Supporting the patients with advanced cancer and their family caregivers: what are their palliative care needs? BMC Cancer. 2020;20(1):768. doi: 10.1186/s12885-020-07239-9.
  21. Muscaritoli M, Molfino A, Scala F, Christoforidi K, Manneh- Vangramberen I, De Lorenzo F. Nutritional and metabolic derangements in Mediterranean cancer patients and survivors: the ECPC 2016 survey. J Cachexia Sarcopenia Muscle. 2019;10(3):517-25. doi: 10.1002/jcsm.12420.
  22. Kiss N, Bauer J, Boltong A, Brown T, Isenring L, Loeliger J, et al. Awareness, perceptions and practices regarding cancer-related malnutrition and sarcopenia: a survey of cancer clinicians. Support Care Cancer. 2020;28(11):5263-70. doi: 10.1007/s00520-020-05371-7.
  23. Murphy JL, Munir F, Davey F, Miller L, Cutress R, White R, et al. The provision of nutritional advice and care for cancer patients: a UK national survey of healthcare professionals. Support Care Cancer. 2021;29(5):2435-42. doi: 10.1007/ s00520-020-05736-y.
  24. Hardcastle SJ, Maxwell-Smith C, Hagger MS, O’Connor M, Platell C. Exploration of information and support needs in relation to health concerns, diet and physical activity in colorectal cancer survivors. Eur J Cancer Care (Engl). 2018;27(1). doi: 10.1111/ecc.12679.
  25. Kassianos AP, Coyle A, Raats MM. Perceived influences on post-diagnostic dietary change among a group of men with prostate cancer. Eur J Cancer Care (Engl). 2015;24(6):818-26. doi: 10.1111/ecc.12357.
  26. Sutton E, Hackshaw-McGeagh LE, Aning J, Bahl A, Koupparis A, Persad R, et al. The provision of dietary and physical activity advice for men diagnosed with prostate cancer: a qualitative study of the experiences and views of health care professionals, patients and partners. Cancer Causes Control. 2017;28(4):319-29. doi: 10.1007/s10552-017-0861-7.
  27. Ashghali Farahani M, Mohammadi E, Ahmadi F, Mohammadi N. Factors influencing the patient education: a qualitative research. Iran J Nurs Midwifery Res. 2013;18(2):133-9.
  28. Holmes RA. Role of dietitians in reducing malnutrition in hospital. Cmaj. 2019;191(5):E139. doi: 10.1503/cmaj.71130.
  29. Fleurke M, Voskuil DW, Beneken Genaamd Kolmer DM. The role of the dietitian in the management of malnutrition in the elderly: a systematic review of current practices. Nutr Diet. 2020;77(1):60-75. doi: 10.1111/1747-0080.12546.
  30. Aktas A, Walsh D, Galang M, O’Donoghue N, Rybicki L, Hullihen B, et al. Underrecognition of malnutrition in advanced cancer: the role of the dietitian and clinical practice variations. Am J Hosp Palliat Care. 2017;34(6):547-55. doi: 10.1177/1049909116639969.
  31. Dehghan-Nayeri N, Shali M, Navabi N, Ghaffari F. Perspectives of oncology unit nurse managers on missed nursing care: a qualitative study. Asia Pac J Oncol Nurs. 2018;5(3):327-36. doi: 10.4103/apjon.apjon_6_18.
  32. Tchounzou R, Simo Wambo AG, Njamen TN, Ilick IO, Neng HT, Dadao F, et al. Patients lost to follow-up for cervical cancer in the Limbe Regional Hospital. J Glob Oncol. 2019;5:1-5. doi: 10.1200/jgo.18.00067.
  33. Osman NS, Md Nor N, Md Sharif MS, Hamid SBA, Rahamat S. Hospital food service strategies to improve food intakes among inpatients: a systematic review. Nutrients. 2021;13(10):3469. doi: 10.3390/nu13103649.
  34. Al-Kalaldeh M, Amro N, Qtait M, Alwawi A. Barriers to effective nurse-patient communication in the emergency department. Emerg Nurse. 2020;28(3):29-35. doi: 10.7748/ en.2020.e1969.
  35. Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68(5):356-76. doi: 10.3322/caac.21490.
  36. Søndergaard EG, Grøne BH, Wulff CN, Larsen PV, Søndergaard J. A survey of cancer patients’ unmet information and coordination needs in handovers--a cross-sectional study. BMC Res Notes. 2013;6:378. doi: 10.1186/1756-0500-6-378.
  37. Shamsi A, Peyravi H. Nursing shortage, a different challenge in Iran: a systematic review. Med J Islam Repub Iran. 2020;34:8. doi: 10.34171/mjiri.34.8.
  38. Tamata AT, Mohammadnezhad M. A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nurs Open. 2023;10(3):1247-57. doi: 10.1002/ nop2.1434.
  39. Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage - a prospect of global and local policies. Int Nurs Rev. 2019;66(1):9-16. doi: 10.1111/inr.12473.
  40. Rangriz H, Moosavi SZ. General health policies and the effect of burnout by overworks on the shortage of nurses in Iranian hospitals. Quarterly Journal of The Macro and Strategic Policies. 2014;2(7):43-64. [Persian].
  41. Hassani M. Impact of sanctions on cancer care in Iran. Arch Bone Jt Surg. 2018;6(4):248-9.
  42. Aloosh M, Salavati A, Aloosh A. Economic sanctions threaten population health: the case of Iran. Public Health. 2019;169:10-3. doi: 10.1016/j.puhe.2019.01.006.
  43. Shahabi S. International sanctions: sanctions in Iran disrupt cancer care. Nature. 2015;520(7546):157. doi: 10.1038/520157b.