A survey of bolus feeding practices in the UK home enteral feeding population

Abstract

The British Artificial Nutrition Survey (2011) suggests that over 26,600 adult patients receive home enteral tube feeding (HETF) in the UK [1], and that this population is a mix of those who are bed bound/sedentary and those who are very active. Anecdotal evidence from clinicians suggests that the use of bolus feeding regimens is increasing compared to continuous/overnight feeding, allowing feeding to fit in with patient and carer lifestyles, however there is very little published evidence and understanding of this growing practice in HETF in the UK. Therefore a preliminary survey to investigate and characterise the numbers and types of adult HETF patients receiving a bolus feeding regimen was undertaken. A survey of adult (≥18 years) tube fed patients (total n=1833), who were receiving part or all of their tube feeding via a bolus feeding regimen, was undertaken across 10 HETF services in the UK between November 2015 and May 2016. A standardised questionnaire, which included patient demographics (age, gender, primary diagnosis, residential status, working status, activity level), tube type and feeding regimen details (type of feed, method, duration) and reasons for bolus feeding, was completed for each patient from their dietetic notes. Patients with bolus tube feeding regimens represented 33% (n=609) of the total HETF population surveyed. Bolus fed patients (mean age 58 years (SD 20, range 18–97), 59% male), had an average time on tube feeding of 4 years 1 month (SD 4 years 6 months, range 2 months–23 years 7 months) and an average time on a bolus feeding regimen of 3 years 6 months (SD 3 years 11 months, range 26 days–20 years 4 months). The majority of patients (73%) were fed via percutaneous endoscopic gastrostomy (PEG), resided in their own/family homes (70%) or in nursing homes (23%), and most patients were either bed/chair bound or very sedentary (69%), with the majority of patients not working (61%) or being retired (34%). Only 2% of patients were working. The most common primary diagnosis was head and neck cancer (21%), followed by stroke (16%) and cerebral palsy (12%). The head and neck cancer population were found to be much more active (78%) than the rest of the bolus fed population (30%), (seated work – moderate exercise). Of the patients surveyed, the large majority (74%) were using bolus feeding as their primary method of tube feeding either via syringe (51%) or by gravity feeding (40%). The most common reasons for choosing a bolus feeding regimen were: to top up the oral diet (20%), to mimic meal times (16%), easy (15%) and quick (12%) to use. The most commonly used feeds for bolus feeding were oral nutritional supplements (59%), with the highest proportion of these (51%) being 2.4 kcal/ml compact-style supplements. We understand this to be the largest survey of its kind specifically assessing the demographics and feeding practices of adult bolus fed patients in the UK, and showing that 1/3 of HETF patients are bolus fed. This survey largely demonstrates similarities between the demographics of those on bolus feeding regimens and the total HETF population as reported in BANS [1], although there does appear to be a dominant subgroup of head and neck cancer patients, who may be bolus feeding for different reasons. Further research is required to understand this patient group, possibly with the inclusion of specific questions regarding bolus feeding being included in future BANS surveys. Reference [1] Smith T, Micklewright A, Hirst A, Stratton RJ, Baxter J. Annual BANS Report 2011. Artificial Nutrition Support in the UK 2000–2010. BAPEN.