Patients’ and health professionals’ experience with home parenteral therapy

Background: The literature review showed a lack of investigation into the patients’ preparation and training on the use of injectable medications out of the hospital setting, its impact on their experience with therapy, and their health outcomes. There is some evidence that the patients might achieve competence with their home parenteral therapy, but they might not achieve confidence. Providing continuous access to advice can boost confidence, but the information needs of patients are often not met. Poor communication can leave patients lacking the knowledge and confidence needed to be competent collaborators in their own care, and affect their perceptions of the service, even when they have positive health outcomes. Aim: This thesis aimed to explore the patients’ and healthcare professionals’ (HCPs) experience regarding home parenteral therapy (HPT), including challenges and opportunities for future homecare services improvements and training standardisation within the UK. Methods and design: This was a mixed method study, which included a clinical audit, qualitative patient interviews regarding their experiences with training prior to commencing HPT, followed by patient and HCP surveys, then finally the development of an example education pathway. Results: A clinical audit of records of patients discharged on extended injectable anticoagulants therapy confirmed that the training on self-injecting and the continuation of treatment post-discharge was not well documented or managed on discharge. The assessment of self-injecting technique and cognitive ability to self-care and manage injectables post-discharge, was also not documented, nor communicated effectively to the primary care team (97.8% of patients had no evidence in their discharge summaries that checks were made to ensure the person discharged was able to use their injectable therapy correctly). A cross-sectional survey-based study was then conducted among 110 consented patients (out of 640 approached), who were identified to be on HPT for various medical conditions, as well as 39 HCPs involved with HPT in a UK hospital NHS Trust. This was to explore their knowledge, experience, perceptions, and opinions regarding the training received related to HPT, and to understand the instruments used for starting patients on HPT. Findings show significant differences in opinions and perceptions on HPT and associated training between these two groups. A qualitative study was then conducted using a semi-structured phone interview with 45 consented patients. Data were explored using an inductive thematic analysis approach to identify key themes relating to patients’ experiences and perceptions of the strengths and challenges of HPT. Patients described various strengths and positive experiences with HPT, while also identifying several challenges they were facing. Feedback was collected about the produced patient educational material. Conclusion: The qualitative information gathered from the clinical audit and patient interviews as well as the qualitative and quantitative data from the questionnaire survey of patients and HCPs were used to create a training package concept and to suggest strategies for improving homecare service in the UK.

Citation

Puzovic, M. (2023) Patients’ and health professionals’ experience with home parenteral therapy. University of Wolverhampton. http://hdl.handle.net/2436/625245

Publisher

University of Wolverhampton

URI

http://hdl.handle.net/2436/625245

Type

Thesis or dissertation

Language

en

Description

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.

Rights

Attribution-NonCommercial-NoDerivatives 4.0 International

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Theses and Dissertations