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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Nutrition | Research article

A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery

Authors: Megan Rattray, Shelley Roberts, Ben Desbrow, Martin Wullschleger, Tayla Robertson, Ingrid Hickman, Andrea P. Marshall

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Enhanced Recovery After Surgery (ERAS) guidelines recommend early oral feeding with nutritionally adequate diets after surgery. However, studies have demonstrated variations in practice and poor adherence to these recommendations among patients who have undergone colorectal surgery. Given doctors are responsible for prescribing patients’ diets after surgery, this study explored factors which influenced medical staffs’ decision-making regarding postoperative nutrition prescription to identify potential behaviour change interventions.

Methods

This qualitative study involved one-on-one, semi-structured interviews with medical staff involved in prescribing nutrition for patients following colorectal surgery across two tertiary teaching hospitals. Purposive sampling was used to recruit participants with varying years of clinical experience. The Theoretical Domains Framework (TDF) underpinned the development of a semi-structured interview guide. Interviews were audio recorded, with data transcribed verbatim before being thematically analysed. Emergent themes and sub-themes were discussed by all investigators to ensure consensus of interpretation.

Results

Twenty-one medical staff were interviewed, including nine consultants, three fellows, four surgical trainees and five junior medical doctors. Three overarching themes emerged from the data: (i) Prescription preferences are influenced by perceptions, experience and training; (ii) Modifying prescription practices to align with patient-related factors; and (iii) Peers influence prescription behaviours and attitudes towards nutrition.

Conclusions

Individual beliefs, patient-related factors and the social influence of peers (particularly seniors) appeared to strongly influence medical staffs’ decision-making regarding postoperative nutrition prescription. As such, a multi-faceted approach to behaviour change is required to target individual and organisational barriers to enacting evidence-based feeding recommendations.
Appendix
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Metadata
Title
A qualitative exploration of factors influencing medical staffs’ decision-making around nutrition prescription after colorectal surgery
Authors
Megan Rattray
Shelley Roberts
Ben Desbrow
Martin Wullschleger
Tayla Robertson
Ingrid Hickman
Andrea P. Marshall
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Nutrition
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4011-7

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