Clinicians' post-operative feeding decisions for infants with congenital duodenal obstruction and trans-anastomotic tube usage: a qualitative interview and focus group study.

BACKGROUND

Congenital Duodenal Obstruction (CDO) is a rare birth defect requiring post-surgical nutritional support, using parenteral nutrition (PN), trans-anastomotic tubes (TAT), or both. TATs offer health and cost benefits, but widespread variation in practice exists: most infants receive PN, and few are fed solely via a TAT. This study aimed to understand how and why clinicians make post-operative feeding decisions for infants with CDO focusing on TATs, and to identify requirements for practice change to increase TAT use and reduce PN.

METHODS

Clinicians working in paediatrics in the UK's National Health Service took part in online interviews (N = 25) and three subsequent focus groups (N = 17 participants). Interviews were coded using thematic analysis to generate themes to understand current feeding practices. Interviewees were sampled purposively to attempt to achieve diversity across workplace location, clinical role, and TAT practice, resulting in participants from 13 different centres and a near-equal distribution of TAT usage: 9 who always or often use TATs, 8 who sometimes use them, and 8 who rarely or never do. Focus groups were used to refine and prioritise interventions for increasing TAT usage.

RESULTS

Interview analysis resulted in four interconnected themes, covering confidence and skills, research scepticism, perceived risks, and organisational inertia. Clinicians requested research demonstrating TATs' safety and effectiveness that largely already exists in the published literature, suggesting the primary barrier to TAT use is a lack of knowledge translation rather than a lack of evidence. Proposed interventions centred on dissemination of existing research and TAT-specific multidisciplinary education and training.

CONCLUSIONS

Clinicians' reluctance to use TATs is multifaceted, rooted in experiential, organisational, and knowledge-based barriers. Increasing TAT usage does not necessarily require new research: dissemination of existing evidence alongside standardised, multidisciplinary education and care pathways should be the immediate priority.