The burden of meal-related challenges in patients with COPD: Who cares?

Introduction: As nutritional status is an indicator of both prognosis and outcome in relation to COPD, it is relevant to investigate how to improve nutritional intake through a knowledge of meal-related challenges. Aim: To investigate the behaviour and experiences of individuals diagnosed with COPD when faced with challenges in meal-related situations. Methods: This study used a phenomenological hermeneutic approach based on participant observations and informal conversations in both secondary and primary health care settings. From August 2018 until February 2019, 34 hours of meal-related observations and informal conversations with 14 patients were completed at a Danish Department of Respiratory Medicine and in patients’ private homes. The empirical data was collected and analysed using Spradley and Ricoeur. Results: This study reveals a lack of respect for the meal situation and shows that the professional responsibility in the face of meal-related challenges is unclear. Patients select dishes based on the texture of the food instead of on their taste preferences, which may limit their nutritional intake. The study shows that patients are hesitant to communicate their needs about nutrition and meal-related situations, which leaves a number of non-verbalised challenges unattended. Conclusion: The overall burden of meal-related challenges poses a risk of decreasing nutritional intake, thereby increasing the risk of undernutrition. Further research is needed to measure the prevalence of the meal-related challenges identified, and to develop interventions that can accommodate these.