Challenges in feeding jejunostomy management: A call for better patient support

Abstract

We read with great interest the article written by Kim et al.1 on their insightful Pilot study of a telehealth intervention for personalized self-management for eating symptoms after gastroesophageal cancer surgery. This randomized trial highlights the potential of telehealth interventions led by nutritionists to improve the quality of life (QOL) for patients post-gastroesophageal cancer surgery. The study's randomized design provides robust evidence on the feasibility and acceptability of telehealth interventions. The inclusion of diverse patient populations (English, Spanish, and Mandarin speakers) enhances the generalizability of the findings. One notable area for potential enhancement involves the development of a more comprehensive therapeutic education platform. While the study utilized a guidebook with a food symptom diary, incorporating multimedia resources could significantly benefit patients with reading difficulties or language barriers. A digital platform featuring well-defined educational videos could provide visual and auditory instructions, facilitating better understanding and compliance with dietary recommendations.2 Additionally, such a platform could support telehealth interventions by preparing patients for sessions and enabling remote monitoring of symptoms.3 This approach could also be extended to palliative care patients, who often endure greater discomfort and symptom burden. For instance, patients with oesogastric cancers undergoing jejunostomy placements could particularly benefit from enhanced educational resources to manage their condition more effectively. Improved patient education can lead to better symptom management, reduced emergency visits, and overall improved QOL. Building on the importance of patient education and management, we conducted a qualitative study focusing on the postoperative experience of patients with feeding jejunostomies. This study involved a cohort of patients treated with curative or palliative intent, whose treatment pathways necessitated the placement of feeding jejunostomies due to esogastric or head and neck cancers. Semi-structured interviews were conducted with either the surviving patients or a family member who accompanied them throughout the treatment process. The average age of our patients was 59 years, ranging from 32 to 82 years. The success rate for feeding jejunostomy placements was 94%, although 5.5% of patients experienced fatal postoperative complications. Comorbidities were prevalent, with 28% of patients (15 patients) classified as ASA 2, and 78% found to be malnourished. The average hospital stay postsurgery was 3 days, and the readmission rate was 1.8%, with only one patient requiring feeding jejunostomy replacement. Participant recruitment and data collection: Participants were recruited from a prospective database at the Department of Surgical Oncology of the National Institute of Oncology between January 1, 2021 and December 31, 2022,,4 informed consent was received. Semi-structured interviews were designed to allow flexibility in exploring individual experiences while maintaining consistency in data collection, respecting all ethical considerations according to local laws. Interview process: Interviews were conducted in-person or via telephone, recorded with consent, and transcribed verbatim. Each interview lasted approximately 30–60 min. Data analysis: Transcriptions were analyzed using thematic analysis. Coding was performed by two independent researchers to identify recurrent themes and patterns. Member checking was conducted to validate the findings. Our findings indicate that the degree of understanding and management of feeding jejunostomies significantly impacted the patients' quality of life after surgery. Despite receiving standard care instructions, the need for additional consultations highlighted a gap in initial education. Infection control and prevention: Early infections (e.g., wall infections and peritonitis) and late infections (e.g., pus discharge from the orifice) were significant concerns. Mechanical complications: Common issues included tube displacement, obstruction, and leakage, necessitating multiple emergency consultations. Pain management: Pain at the fixation site was frequently reported, affecting comfort and mobility. Educational gaps: A clear lack of family education on feeding jejunostomy care led to repeated emergency visits. Innovative educational approaches are necessary to bridge this gap. Impact on quality of life: The cumulative effect of these issues profoundly impacted postoperative quality of life. Enhanced communication and tailored educational programs could mitigate these challenges, improving overall patient outcomes. Curative intent versus actual outcomes: Despite the intention for curative treatment with feeding jejunostomy placement, patients often had significantly shorter lifespans than anticipated. This raises questions about the appropriateness of the indication for feeding jejunostomy placement. There is a need to re-evaluate the decision-making process, especially when it comes from medical oncologists with curative intent. Furthermore, the reluctance of oncologists to cease palliative chemotherapy until the very end of life highlights a critical issue. This persistent approach may contribute to the overall reduced quality of life and necessitates a balance between aggressive treatment and palliative care. Consideration of less invasive techniques: To further improve patient outcomes and QOL, there is a need to explore less invasive alternatives, such as percutaneous techniques, which could potentially reduce the complications and discomfort associated with traditional feeding jejunostomy placements. These themes underscore the critical need for a comprehensive approach to patient education and care, addressing both medical and psychosocial aspects to achieve better postoperative results. In conclusion, both the study by Kim et al.1 and our findings highlight the crucial role of effective patient education and management in improving postoperative outcomes and quality of life. By adopting innovative educational strategies and leveraging telehealth platforms, we can better support patients in managing their conditions, ultimately leading to improved health and well-being. The authors declare no conflict of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.