Abstract
BackgroundEnhanced 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.MethodsThis 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.ResultsTwenty-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.ConclusionsIndividual 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.
Highlights
Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery
Study design and setting This study was conducted in a constructivist–interpretivist paradigm using semi-structured interviews, underpinned by the Theoretical Domains Framework (TDF) [18], to explore decision-making of surgeons regarding the prescription of nutrition after colorectal surgery
180–200 colorectal resections are performed at each site per year
Summary
Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. Studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Enhanced Recovery After Surgery (ERAS) guidelines assist clinicians in making informed decisions regarding optimal perioperative care among colorectal patients [1, 2]. Oral feeding (EOF), defined as initiating liquids and solids within 24 h after colorectal surgery [1,2,3], is an essential component of ERAS that has proven to be safe and beneficial [4, 5]. Recent studies have demonstrated variable and often poor adherence to EOF recommendations and frequent use of nutritionally inadequate diets (i.e. clear liquids) among patients that undergo gastrointestinal surgery [6,7,8]. Efforts to improve postoperative nutrition prescription practices are needed to optimize patient and healthcare outcomes
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