The role of diet in palliative care as perceived by patients, carers and healthcare professionals

  • Anne Holdoway

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


Amongst patients with incurable cancer, many will experience unintentional weight loss, loss of appetite and a range of symptoms that adversely affect the ability to eat and drink. This thesis explores the role of diet and nutrition in the palliative phase of cancer care as perceived by patients and their carers and the healthcare professionals involved in providing support. The work sought to explore the views on the role of diet before cancer and once diagnosed, the experience and identification of diet-related issues, what mattered and why and the suitability and adoption of management strategies. To explore the issues and complexities, a qualitative approach using case study methodology was considered the most appropriate. Semi-structured interviews were the primary source of data with secondary sources including medical records, policies, training and resources. Interviews and data collected was thematically analysed. Patients with incurable cancer, deemed palliative, were purposively sampled to include a variety of cancer types likely to experience diet-related issues. Each patient was asked to nominate a family member or friend, and two healthcare professionals who had been, or were involved in their care, to participate in the study. Four patients, three carers and seven healthcare professionals participated. Patients had the following cancers: melanoma with brain secondaries; head and neck with lung secondaries; pancreatic cancer; lung cancer with liver metastases. Several overarching themes were identified which included: the complexity of diet, cancer and symptoms; disruption and distortion: the altered meaning of food and preservation of self; identification of what mattered through nutrition conversations and observations; strategies to deal with diet-related issues including adaptations, adjustment, acceptance of a new norm; facilitators of nutritional care including knowledge acquisition, culture and environment. The findings have offered new insights into the identification and management of diet-related issues, weight loss and cachexia in advanced cancer and been used to develop a framework for training and clinical practice. It is hoped dissemination of the findings will assist in shaping strategies to improve nutritional care and provide advice for the growing numbers of patients receiving palliative care.
Date of Award18 Nov 2020
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorPaula Smith (Supervisor) & Christine Baldwin (Supervisor)


  • diet
  • palliative care
  • cancer
  • Qualitative Research
  • nutrition

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