Mealtime challenges in patients with chronic obstructive pulmonary disease: Who is responsible?

Aim: This study is aimed at exploring experiences of, and practices related to, mealtime challenges in patients with COPD. Background: Nutritional status is a significant indicator of prognosis and outcome in patients with COPD. Preventing unintended weight loss and helping patients regain weight are important nursing tasks. Dietary supplements have been effective in treating underweight in cases of stable COPD. However, compliance with long-term interventions is quite low. Improving nutritional intake through knowledge of meal-related challenges is the key to making further progress in preventing unintended weight loss. Design: This study employed an ethnographic design using the go-along method. Methods From September 2018 to June 2019, 34 hours of meal-related observations and informal conversations with purposefully selected patients (n=15) were completed at a Danish Accepted Article This article is protected by copyright. All rights reserved respiratory medicine ward and in patients’ homes. We analysed the empirical data using a Ricoeur-inspired method. Reporting adheres to the COREQ Checklist. Findings In this study, we identified the absence of professional responsibility as a main challenge. Mealtimes appeared to be relegated to a matter of nutrition, and common practices surrounding mealtimes were no longer observed. Patients became dependent individuals who had to settle for the food available. In addition, physiological challenges often resulted in patients re-evaluating the benefits of eating, concluding that it was not worth the effort and therefore not eating. Furthermore, patients were hesitant to communicate their needs, which left a number of non-verbalised challenges unattended. Conclusions Overall, meal-related challenges pose a risk of unintended weight loss, and the health professionals’ work with mealtimes lacks a coordinated, systematic approach. Further research is needed to develop or implement interventions that can accommodate mealtimes.