www.elsevier.com/locate/clnu ORIGINAL ARTICLE The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families Ylva Orrevall a,c, *, Carol Tishelman b,c , Margery K. Herrington d , Johan Permert a a Division of Surgery, Center for Surgical Sciences, Karolinska Institutet, Stockholm, Sweden b Department of Nursing, Karolinska Institutet, Stockholm, Sweden c Research and Development Unit, Center for Surgical Sciences, The Foundation Stockholms Sjukhem, Mariebergsgatan 22, SE-112 35 Stockholm, Sweden d Biology Department, Adams State College, Alamosa, CO, USA Received 4 November 2003; accepted 6 April 2004 Summary Background & aim: Little is known about the perspectives that patients with advanced cancer and their family members have concerning nutritional problems and nutritional support. The aim of this study was to investigate their experiences of the nutritional situation prior to introduction of home parenteral nutrition (HPN) in order to understand factors contributing to the decision to accept HPN. Methods: Semi-structured interviews were conducted with 13 patients with advanced cancer who had received HPN and 11 family members. The constant comparative method was used for data analysis. Results: Patients and family members described the nutritional situation prior to HPN as a source of worry and often desperation. Patients reported wanting and trying to eat, but being unable to do so. Family members experienced powerlessness and frustration, as they could not enable the patient to eat. A lack of attention to nutritional problems by the hospital staff was described. The offer of HPN came when patients and family no longer felt able to solve the nutritional problems within the family. Conclusion: The desperate and chaotic nutritional situation in the family led to willingness to accept HPN. Because of the severity of the problems, HPN was viewed as a positive alternative. & 2004 Elsevier Ltd. All rights reserved. ARTICLE IN PRESS KEYWORDS Food intake; Home parenteral nutrition; Neoplasm; Home care; Palliative care; Family caregivers *Corresponding author. Research and Development Unit, Center for Surgical Sciences, The Foundation Stockholms Sjukhem, Mariebergsgatan 22, SE-112 35 Stockholm, Sweden. Tel.: þ 46-8-6179353; fax: þ 46-8-6179333. E-mail address: ylva.orrevall@cfss.ki.se (Y. Orrevall). 0261-5614/$ - see front matter & 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.clnu.2004.04.006 Clinical Nutrition (2004) 23, 1280–1287