Udvikling af strategi til understøttelse af Morbus Crohn-patienter i kostomlægning blandt sundhedsprofessionelle: Kostomlægning til inflammationshæmmende kost som komplementær behandling til biologisk medicin

Abstract

Baggrund: Morbus Crohn (CD) er en inflammatorisk tarmsygdom, som typisk behandles med biologisk medicin. Da behandlingen er omkostningstung og kan medføre bivirkninger, undersøges det i et ph.d.-projekt, om inflammationshæmmende kost (IFK) kan anvendes som komplementær behandling til CD-patienter i biologisk behandling. Da patienternes efterlevelse af kostinterventionen kan impliceres af barrierer blandt sundhedsprofessionelle ved ambulante besøg, vil dette undersøges. Formål: At undersøge barrierer og facilitatorer for at støtte CD-patienter i en kostomlægning til IFK blandt sundhedsprofessionelle på medicinske mave-tarm ambulatorier i Danmark med henblik på at udvikle en strategi til at imødekomme disse. Metode: Til udviklingen af strategien anvendes MRC-modellen. Der anvendes metodetriangulering af tre datakilder: et litteraturstudie, kvalitative interviews og en spørgeskemaundersøgelse. Data analyseres ud fra de individuelle metodiske tilgange, hvorefter resultaterne herfra integreres i en kritisk fortolkning. Herudfra udvikles strategiske fokuspunkter til at imødekomme barrierer og facilitatorer samt konkrete forslag til, hvordan ph.d.-projektet og fremtidige lignende interventioner kan implementere disse fokuspunkter. Resultater: Resultater fra den kritiske fortolkning vidner om et vidensbehov inden for IFK blandt sundhedsprofessionelle, herunder særligt for sygeplejersker og læger. Resultater fra den statistiske analyse viser, at diætister vurderer at have flere vidensmæssige- (OR 15,73, p=0,009) og tidsmæssige ressourcer (OR 0,03, p=0,011) til at støtte CD-patienter i kostomlægning sammenlignet med sygeplejersker. Endvidere påpeger litteraturstudiet, at diætisters fagkompetencer er underudnyttede, mens et øget tværfagligt samarbejde efterspørges i både den kvalitative- og kvantitative undersøgelse. Læger ses i lavere grad at mene (OR 0,04, p=0,025), at der er en overordnet positiv holdning til inddragelse af IFK i behandlingen af CD sammenlignet med sygeplejersker, hvilket også understøttes af den kvalitative undersøgelse. Fokuspunkter for strategien omhandler derfor at fremme viden om IFK og kostinterventionen blandt sundhedsprofessionelle, positiv italesættelse af kostinterventionen, særligt over for læger, samt et øget tværfagligt samarbejde. Konklusion: Barrierer og facilitatorer blandt sundhedsprofessionelle for understøttelse af kostinterventionen kan imødekommes gennem tre strategiske fokuspunkter: vidensdeling, positiv italesættelse af kostinterventionen og øget tværfagligt samarbejde. Fokuspunkterne og de konkrete forslag relateret hertil kan anvendes til understøttelse af kostinterventionen og bør pilottestes inden udbredelse til andre kontekster.

Background: Morbus Crohn (CD) is a type of inflammatory bowel disease (IBD) which is typically treated with biological medicine. Since the treatment is costly and can cause side- effects, a Ph.D. study is investigating if an anti-inflammatory diet (IFK) is feasible as a com- plementary treatment for CD-patients in biological treatment. Since the patients’ compliance with the dietary intervention can be implied by barriers among health professionals during out- patient visits, these barriers will be investigated. Aim: To investigate perceived barriers and facilitators for supporting CD-patients in dietary change to IFK amongst health professionals at medical gastrointestinal outpatient clinics in Denmark in order to develop a strategy to overcome these. Methods: The MRC-model is used for the development of the strategy. Triangulation of meth- ods are applied through three data sources: a literature review, qualitative interviews, and a survey. Data are analyzed based on the individual methodical approaches after which the re- sults are integrated in a critical interpretation. From here strategic focus points for how to over- come barriers and build on facilitators are developed as well as suggestions for how the Ph.D. project and future similar interventions can implement these. Results: Results from the critical interpretation underline a need for knowledge among health professionals relating to IFK, especially among nurses and physicians. Results from the statis- tical analysis show that dieticians assess having more knowledge (OR 15,73, p=0,009) and time resources (OR 0,03, p=0,011) to support CD-patients in dietary change compared to nurses. Furthermore, the literature review points out that the professional competencies of die- ticians are underutilized, while increased interdisciplinary collaboration is in demand accord- ing to both the qualitative and quantitative study. Physicians are seen to a lesser extent to be- lieve (OR 0.04, p=0.025) that there is an overall positive attitude towards the inclusion of IFK in the treatment of CD compared to nurses, which is also supported by the qualitative study. Focus points for the strategy therefore include promoting knowledge about IFK and the dietary intervention among health professionals, positive communication about the intervention, espe- cially to doctors, as well as increased interdisciplinary collaboration. Conclusion: Barriers and facilitators among health professionals to support the dietary inter- vention can be met through three strategic focus points: knowledge sharing, positive commu- nication about the dietary intervention and increased interdisciplinary collaboration. The fo- cus points and suggestions related to implementing them can be used to support the dietary intervention and should be pilot tested before being transferred to other contexts.

A master thesis from Aalborg University

Udvikling af strategi til understøttelse af Morbus Crohn-patienter i kostomlægning blandt sundhedsprofessionelle: Kostomlægning til inflammationshæmmende kost som komplementær behandling til biologisk medicin

[Development of a strategy to support Crohn's disease patients in dietary change among health professionals: Dietary change to an anti-inflammatory diet as a complementary treatment to biological medicine]