The impact of targeted interventions aimed to improve quality of life in patients receiving home parenteral nutrition: A systematic literature review

BackgroundHome parenteral nutrition (HPN) is a specialised therapy offered to people suffering from intestinal failure. Underlying disease, HPN complications and limitations of HPN can significantly impact a person's quality-of-life (QOL). The aim of this review was to evaluate the evidence on existing non-surgical/non-pharmacological interventions aimed at improving QOL, clinical, patient-reported and economic outcomes for patients receiving parenteral nutrition therapy at home across adult and paediatric settings.MethodsOnline databases Medline (Ovid), Embase and Cinahl were searched to identify studies published between 1937 and 31 March 2022. Identified studies were appraised using the Cochrane Collaboration risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment.ResultsNine studies were included in this review. Interventions were focused on education (n = 4), telemedicine (n = 2), preparation of infusion mixtures (n = 1), mindfulness-based cognitive therapy (n = 1) and a multi-modal approach (n = 1). Only one study measured QOL before and after the intervention using a validated QOL tool. All studies were assessed at either some, high or critical risk of bias, resulting in low or very low-quality evidence for the interventions evaluated.ConclusionsThe findings from this review highlight the lack of high-quality non-surgical/non-pharmacological studies seeking to improve QOL for people on HPN. Because the majority of people receiving HPN are not eligible for surgical or pharmaceutical treatments, higher quality research using clinical trial design, and research focused on improving QOL is needed to inform healthcare managers about the effectiveness (and value) of alternative service delivery models for this vulnerable patient group. The present study highlights the lack of research in identifying interventions that may help to improve quality-of-life (QOL) and other outcomes for people receiving home parenteral nutrition (HPN). Given that the majority of people receiving HPN are not eligible for surgical or pharmaceutical treatments, well-designed research studies are required to guide HPN clinical practice to improve QOL, clinical, patient-reported and economic outcomes.image The present study highlights the lack of research in identifying interventions that may help to improve quality-of-life (QOL) and other outcomes for people receiving home parenteral nutrition (HPN).Given the majority of people receiving HPN are not eligible for surgical or pharmaceutical treatments, well-designed research studies are required to guide HPN clinical practice to improve QOL, clinical, patient-reported and economic outcomes.