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  • A qualitative exploration of factors influencing medical staffs' decision-making around nutrition prescription after colorectal surgery

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    Author(s)
    Rattray, Megan
    Roberts, Shelley
    Desbrow, Ben
    Wullschleger, Martin
    Robertson, Tayla
    Hickman, Ingrid
    Marshall, Andrea P
    Griffith University Author(s)
    Desbrow, Ben
    Marshall, Andrea
    Roberts, Shelley J.
    Year published
    2019
    Metadata
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    Abstract
    Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions. Methods: This qualitative study involved one-on-one, semi-structured interviews ...
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    Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions. Methods: This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation. Results: Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition. Conclusions: Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs’ decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.
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    Journal Title
    BMC HEALTH SERVICES RESEARCH
    Volume
    19
    Issue
    178
    DOI
    https://doi.org/10.1186/s12913-019-4011-7
    Copyright Statement
    © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
    Subject
    Nursing
    Health services and systems
    Public health
    Early oral feeding
    Perioperative nutrition care
    Postoperative nutrition care
    Enhanced recovery after surgery
    Publication URI
    http://hdl.handle.net/10072/384133
    Collection
    • Journal articles

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