Adherence to home parenteral nutrition and/or intravenous fluid infusions in patients with chronic intestinal failure: A multicenter cross-sectional study

Abstract

Background

Patients with chronic intestinal failure (CIF) often experience reduced quality of life due to the psychosocial constraints of home parenteral nutrition (HPN) and/or fluid infusions. Despite its major impact on daily life, adherence to these treatments remains poorly documented.

Aim

To assess adherence to HPN and/or fluid infusions in adult CIF patients and identify associated factors.

Methods

This multicenter, cross-sectional study included CIF patients from six French HPN centers. Eligible patients were ≥18 years old, on HPN and/or fluid infusions for ≥6 months with a stable regimen for ≥3 months. Adherence was assessed via self-reported questionnaires, physician and coordinating nurse evaluations, and phone interviews. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and the Wake Forest Physician Trust Scale measured trust in the physician.

Results

A total of 126 patients were included; 82% had their infusions administered by nurses. Overall, 24% of patients exhibited poor adherence, with 9.5% negotiating treatment and 18% missing infusions. Poor adherence was associated with low weekly infusion volume (<7750 mL, odds ratio [OR] 3.31, 95% confidence interval [CI] [1.09–11.2], P = 0.041), high anxiety scores (OR 5.29, 95% CI [1.58–19.2], P = 0.008), and low trust in physicians (Wake Forest Physician Trust Scale, OR 0.90, 95% CI [0.82–0.98], P = 0.018). Coordinating nurses’ perception strongly predicted adherence.

Conclusions

One in four CIF patients showed poor adherence. Those with low infusion volumes, high anxiety, or low physician trust require close monitoring. Coordinating nurses play a key role in identifying non-adherence.