Abstract
Patients with functional gastrointestinal tract who are unable to meet their nutritional requirements may benefit from the use of enteral nutrition via feeding tubes which could be nasogastric, percutaneous endoscopic gastrostomy and jejunostomy. Although enteral tube feeding has been shown to promote nutritional status, improve wound healing, and enhance patients’ quality of life (QoL), evidence of tube and feed complications and reduced QoL has also been reported. Despite the increasing prevalence of patients on enteral tube feeding, no systematic review examining the role of enteral tube feeding on patients’ QoL appears to have been published. Aim: The aim of this systematic review is to evaluate the effect of enteral tube feeding on patients’ QoL. Method: Three databases (EMBASE, Pubmed, and PsycINFO) plus Google Scholar were searched for relevant articles based on the Population, Intervention, Comparator, Outcomes (PICO) framework. The review was in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines and involved the use of synonyms and medical subject headings. In addition, search terms were combined using Boolean operators (AND/OR) and all the articles retrieved were exported to EndNote for de-duplication. Results: Fourteen articles which met the criteria were included and three distinct areas were identified: the effect of early versus late enteral tube feeding on QoL; the QoL of patients on gastrostomy versus standard care, and the effect of enteral tube feeding on QoL. Overall, nine studies reported improvement in the QoL of patients on enteral tube feeding, while five studies demonstrated either no significant difference or reduction in QoL. Some factors which may have influenced these outcomes are differences in types of gastrostomy tubes, enteral feeding methods (including time patients spent connected to enteral feed/pump), and patients’ medical conditions, as well as the generic and/or type of QoL measuring instrument used. Conclusion: Most reviewed studies suggest that enteral tube feeding is effective in improving patients’ QoL. The use of enteral tube feeding-specific QoL measuring instruments is recommended for future research, and improved management strategies including use of mobile enteral feeding pumps should further enhance patients’ QoL. More studies on the effect of delivery systems/enteral feeding pumps on QoL are needed as research in this area is limited.
Highlights
There is evidence of increasing prevalence of patients on enteral tube feeding in the UK and around the world [1,2] and this calls for greater scrutiny in terms of evaluating the impact of this method of feeding on patients’ quality of life (QoL)
Some factors which may have influenced these outcomes are differences in types of gastrostomy tubes, enteral feeding methods, and patients’ medical conditions, as well as the generic and/or type of QoL measuring instrument used
Evaluation of the selected studies on the impact of enteral tube feeding on QoL resulted in the emergence of 3 distinct areas with different outcomes observed in each area
Summary
There is evidence of increasing prevalence of patients on enteral tube feeding in the UK and around the world [1,2] and this calls for greater scrutiny in terms of evaluating the impact of this method of feeding on patients’ quality of life (QoL). Enteral tube feeding is an effective method of providing nutritional support to these patients and other patients with functional guts who are unable to meet their nutritional requirements through the oral route alone due to a range of conditions [6,7]. Patients with chronic conditions such as stroke, multiple sclerosis, moto—neuron disease and dementia which may impact the patient’s swallowing ability usually require enteral nutrition support to promote clinical outcomes [5,8]. Despite the merits in the use of enteral tube feeding, challenges such as its impact on patients’ QoL remain
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