Nutritional management for patients with advanced head and neck cancer from the perspectives of healthcare professionals: A descriptive qualitative study

Background: Patients with advanced head and neck cancer are at risk of malnutrition, affecting quality of life due to the tumour location and side effects of cancer treatment. As a result, nutrition is likely to deteriorate as the disease progresses. Objectives: To explore healthcare professionals’ experiences of managing nutrition in patients with advanced head and neck cancer. Designs: A descriptive qualitative design was adopted using semi-structured interviews during which the complexity, factors and decision-making processes involved in nutritional management were explored in depth. Interviews were conducted over video call and analysed using reflective thematic analysis. Settings/subjects: Twenty-one healthcare professionals from the United Kingdom, including Dietitians, Clinical Nurse Specialists and Speech and Language Therapists, were interviewed. Results: Four themes were identified: (1) The importance of individualised nutritional care; (2) Complex decision-making regarding feeding tubes which included prognosis, patient preferences and the ‘window of opportunity’; (3) Differing expectations and experiences of patients and family; (4) Shifting nutritional priorities. Conclusions: The management of nutrition for patients with advanced head and neck cancer is complex. Healthcare professionals are required to consider multiple factors when providing nutritional support to patients. This includes making complex decisions around what enteral feeding tubes should be used and when, navigating the dynamics between patients and family, managing changing nutritional goals with disease progression and creating a nutritional plan reflecting individual needs and preferences. Further research is needed to strengthen shared decision-making frameworks, refine the understanding of the ‘window of opportunity’ and develop a core outcome.