Dietary Patterns Following an Episode of Acute Pancreatitis: A Post Hoc Analysis From the PAPPEI Multicenter, Prospective Study.

Eating disorders (EDs) are a group of complex conditions generally characterised by dietary behaviours that are detrimental to health and driven by experiences of challenging thoughts, feelings, and emotions relating to food and/or the body []. They are caused by a combination of biological, psychological, and social factors, have serious physical, psychological, and social impacts, and present significant healthcare challenges [, ]. Chief among these challenges is supporting those receiving treatment for EDs in inpatient settings to voluntarily consume enough food and fluids to restore and promote health []. When this challenge is deemed insurmountable and there is a perceived risk to life, it is common for patients to be detained under the mental health act and subjected to involuntary treatments including nasogastric tube (NGT) feeding under restraint [–]. Delivering NGT feeding under restraint to patients with restrictive EDs is often justified on the grounds of preserving life. However, while it can be lifesaving, it can also cause physical injuries, be traumatising for patients and staff, and may promote resistance to further therapeutic support [, ]. International organisations, healthcare professionals, patients, and researchers have all highlighted a need to limit the use of coercive and restrictive interventions in mental health care []. In 2015, the United Kingdom’s (UK) Mental Health Act 1983 Code of Practice was updated with clear expectations for mental health services to commit to reducing the use of restrictive interventions, including use of restraint []. The need to move away from coercive and authoritarian treatment protocols has been stressed in research on EDs specifically, with a call to focus on collaborative decision-making to improve treatment outcomes []. However, the clinical decision-making process in EDs treatment can be complex, and healthcare professionals regularly face ethical dilemmas relating to involuntary or coercive treatment and the physical and mental health of people in their care []. Decisions related to NGT feeding under restraint are fraught with these complexities and the associated risks are compounded by differing knowledge and priorities of various staff, patients, and families/carers involved in the treatment process. The unique combination of each patient and treatment context means this intervention can have vastly different outcomes ranging from positive (promoting/supporting recovery) to detrimental (unintentional exacerbation of condition and/or additional harms, e.g., trauma). Decision-making is further complicated by key operational concepts such as ‘lifesaving circumstances’, ‘recovery’ and ‘successful treatment’ being poorly and/or variously defined and open to interpretation [, ]. Despite the complexities and potential iatrogenic consequences, NGT feeding under restraint is an under-researched intervention in EDs treatment and there is a lack of consensus or evidence-based guidance on best practice [, , ]. Indeed, it is currently unclear what information is available to EDs clinicians to inform their clinical practice.