| The psychological and social impact of home parenteral nutrition was explored utilizing the Corbin and Strauss Chronic Illness Trajectory Framework. Fifty subjects completed four instruments on quality of life (QLI), functional health status (SF-36), sleep quality (PSQI), depressive symptoms (HADS) and a questionnaire on HPN administration and demographics. Six subjects were interviewed. The subjects showed differences in quality of life, physical functional health status, and quality of sleep from healthy and chronically ill populations. The mental/emotional health functioning and depressive symptoms were similar to healthy adults. Evaluation of HPN subjects in 4 of 5 trajectory phases of illness demonstrated similar scores for quality of life, functional health status, and depressive symptoms. These findings were similar for the subjects with long and short-term trajectory projections. The subjects in the downward phase/palliative projection described poor quality of life, worse emotional health and more depressive symptoms. The trajectory scheme represented by the HPN administration variables, revealed subjects on HPN > 2 years scored higher on mental/emotional health and had less depressive symptoms than subjects on HPN < 2 years. Subjects infusing HPN 3--5 days per week as well as subjects infusing a volume of 2250 ml or greater and longer than a 12-hour cycle reported slightly better quality of life, worse physical function and quality of sleep. The interview data supported these finding with rich descriptions of physical limitations, social disruptions, altered lifestyles, disrupted sleep, and complaints of lack of energy and fatigue. |
