ORCHID Annual Report 2023 - Flipbook - Page 15
Project Aims:
1. To systematically review the literature investigating complications and outcomes of gastrostomy use in
paediatric bone marrow transplantation
2. To survey current nutritional practices and opinions towards gastrostomy use between dietitians, doctors,
and nurses across paediatric bone marrow transplantation centres in the United Kingdom
3. To conduct a prospective cohort study comparing complications and outcomes of gastrostomy versus
nasogastric tubes from admission to six months post bone marrow transplantation 4. To interview parents
and children to explore why they did or did not choose a gastrostomy and what their experience of tube
feeding were throughout bone marrow transplantation.
This was a multi-phase, parallel mixed-methods study. Phase one included aims 1 and 2 which were
completed throughout 2021. The systematic review found 55% of children developed >1 gastrostomy
complication and gastrostomy feeding was associated with improvement or stabilisation of nutrition status in
77%–93% of children. The survey showed 42% of centres used gastrostomies, but in these centres 76% of
clinicians felt some children, 14% felt all children, should be offered a gastrostomy.
Phase two included aims 3 and 4 which completed in January 2023. The cohort study found 87% of children
developed >1 gastrostomy complication but 94% were minor. No differences were found between tubes on
how well they supported children9s nutritional intake or status throughout transplant. The family interviews
showed choice was experienced by spectrums of difficulty and freedom. Some parents had complete
freedom to choose whereas others were told which to have by clinicians. Parents valued choice with an
appreciation one feeding tube might not suit every child. Influential factors in decision making included
expected duration of need, the child9s age, activity, cosmetic differences, balancing pros and cons of each
tube, lay advice, clinician9s recommendations and prior experiences.
This project produced recommendations for gastrostomy feeding and findings will help decision making
between families and clinicians regarding options for tube feeding for bone marrow transplantation. James
passed his viva in September 2023.
Awards
Evans J. Awarded Doctorate from UCL Great Ormond Street Institute of Child Health, December 2023
Digital profile:
ORCiD ID: 0000-0003-2383-8984
Google Scholar: https://scholar.google.co.uk/citations?user=KNkO4DcAAAAJ&hl=en&oi=ao
Peer reviewed publications
Evans J, O’Connor G, Green D, Gibson F, Lanigan J. (2023) Complications and outcomes of gastrostomy
versus nasogastric tube feeding in paediatric allogeneic bone marrow transplant: a prospective cohort study.
Clinical Nutrition ESPEN (European Society for Clinical Nutrition and Metabolism), 55:58-70
https://doi.org/10.1016/j.clnesp.2023.02.022
Published abstracts
Evans J, Green D, O'Connor G, Lanigan J, Gibson F. (2023) Similar outcomes but different experiences
of gastrostomy versus nasogastric tube feeding in pediatric bone marrow transplant: a mixed methods study.
Bone Marrow Transplantation, 58, 629-629. https://doi.org/10.1002/ncp.10724
Conference presentations
Evans J. Outcomes and experiences of gastrostomy versus nasogastric tube feeding in pediatric bone
marrow transplant: a mixed methods study, European Bone Marrow Transplant (EBMT) Society Annual
Meeting Paris, 23-26 April 2023
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