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Quality of life of patients on long-term total parenteral nutrition at home

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Abstract

Quality of life and quality-adjusted survival were measured for a cohort of 73 patients maintained on long-term parenteral nutrition at home (HPN) for periods ranging from six months to 12 years. Quality-adjusted survival was also modeled (although not directly observed) for this cohort under alternative therapeutic strategies (e.g., parenteral nutrition in hospital as needed). Using three utility assessment techniques (category scaling, time-tradeoff, direct questioning of objectives), quality of life was measured through interviews with 37 patients. The quality of life of the patients interviewed was good (mean value 0.73 where 0 represents death and 1.0 represents perfect health); for those who had experienced a period of chronic malnutrition before HPN, quality of life had improved. For the entire cohort, the estimate of quality-adjusted survival was four times greater with HPN than with the alternative therapeutic strategies (p<0.001). In comparison with alternative strategies, HPN significantly improves the quality of life of patients unable to sustain themselves with oral alimentation. Quality of life (utility) techniques can be used to evaluate the effectiveness of interventions for patients with chronic diseases.

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Authors and Affiliations

  1. Department of Health Administration, University of Toronto, McMurrich Building, Second Floor, M5S 1A8, Toronto, Ontario, Canada

    Allan S. Detsky MD, PhD

Authors
  1. Allan S. Detsky MD, PhD
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  2. John R. McLaughlin MSc
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  3. Howard B. Abrams MD
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  4. Kristan A. L’Abbe MSc
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  5. Jocelyn Whitwell BScN
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  6. Claire Bombardier MD, MSc
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  7. Khursheed N. Jeejeebhoy MBBS, PhD
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Additional information

Received from the Departments of Health Administration and Medicine, University of Toronto, and the Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.

Supported by the Ontario Ministry of Health (DM602) and also in part by the National Health Research and Development Program through a National Health Research Scholar Award to Dr. Detsky.

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Detsky, A.S., McLaughlin, J.R., Abrams, H.B. et al. Quality of life of patients on long-term total parenteral nutrition at home. J Gen Intern Med 1, 26–33 (1986). https://doi.org/10.1007/BF02596321

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  • DOI: https://doi.org/10.1007/BF02596321

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