The impact of home parenteral nutrition on daily life - A review

Background: Total parenteral nutrition (TPN) is a lifesaving therapy in patients with severe intestinal, faiture that can be administered at home. However, patients have to face complex technological nutritional support issues at home, which will influence their personal life. Objectives: This review aims to describe the implications of home parenteral nutrition (HPN) on the quality of life, as experienced by patients, as well as to describe the caregiver's reactions regarding these notions. Search strategy: A systematic review of the Literature published between 1965 and 2005 was conducted. Cinahl, Medline, and Psychlit databases were searched. Systematic data extraction and narrative data synthesis were performed. Selection criteria: Papers were included if they described original research published in a peer reviewed journal, with a focus on adult patients on HPN and/or their family caregivers. Data collection (and analysis): A standardised record was used for data extraction. Main results: A total of 26 studies were included. The quatity of life reported by patients was moderate to good, but psychological problems, e.g. depression and anxiety, were common. Social life was disturbed due to the venous access device, the time schedule for HPN administration, the inability to have normal orat intake, gastrointestinal mobility problems, and physical complaints. Frequently mentioned somatic problems included fatigue, diarrhoea, pain, polyuria during infusion and steep disruption. Despite social restrictions, depression and fatigue, caregivers reported their overall QOL as similar to the norms for healthy populations. Conclusion: Patients on HPN meet a broad range of problems. Apart from the well-known metabolic and infectious complications, many of these are psychological or social in nature. (c) 2006 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.