Identifying patients with benign chronic intestinal failure on home parenteral nutrition in whom a psychological support intervention may improve quality of life.

Geert Wanten,Getty Huisman-De Waal,Judith Beurskens-Meijerink

doi:10.1016/j.clnesp.2020.12.026

Abstract

Home parenteral nutrition (HPN) is the ultimate treatment for patients who suffering from chronic intestinal failure (CIF). We tested the feasibility and effects of Mindfulness Based Cognitive Therapy (MBCT) in patients on HPN. Because of the high dropout rate, however, we were next urged to develop and test a web-based coaching program (web-based MBCT). The aim of the present study was to compare the effects of MBCT with this web-based MBCT. A quasi-experimental pilot study was conducted in a tertiary referral center for CIF in the Netherlands to evaluate the feasibility of both a MBCT and the internet-based MBCT intervention. In 2016 we included 17 patients in the MBCT group. These patients followed MBCT training. End of 2016 an internet-based online MBCT program was constructed for which we invited 14 patients and their caregivers. In the MBCT 5 out of 17 patients (29%) completed their therapy. Patients attributed positive effects to their acquired mindfulness skills and reported a better QoL. In the internet-based mindfulness therapy group 2 out of 14 patients (14%) fulfilled the training sessions. Also, six caregivers started the training in this latter group and one caregiver fulfilled the training. The study suggests that both MBCT and the internet-based MBCT are no feasible strategies to decrease disease burden and improve QoL for CIF patients and their caregivers due to the intensity of these programs on one side and the experienced physical limitations on the other. The patients who fulfilled the program were positive and use MBCT in daily practice.

Highlights

Home parenteral nutrition (HPN) is a life-saving therapy for patients suffering from intestinal failure (IF)
We examine the feasibility of Mindfulness Based Cognitive Therapy (MBCT) as a means to modulate and improve the coping strategy of HPN patients
Poor quality of life is reported in association with the burden, anxiety and depression related to HPN support and should be prioritized for psychological support because of this increased risk and the impact of chronic intestinal failure (CIF) for the individual [8]

Summary

Introduction

Home parenteral nutrition (HPN) is a life-saving therapy for patients suffering from intestinal failure (IF). In long-term IF patients parenteral nutrition is administered in the home setting (HPN). Few studies show the range of problems that HPN patients experience [1]. Psychosocial problems, depression, social impairment and fatigue and previously experienced venous access complications have been strongly associated with a lower Qol [1,2]. Mindfulness Based Cognitive Therapy (MBCT) has shown the potential to improve Qol in other clinical settings [3]. Earlier studies have shown that web-based mindfulness interventions appear to be an acceptable and valid alternative to existing MBCT treatments with great satisfaction and acceptance for the training [4e6]

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