Patient and clinician perspectives on supported mealtimes as part of anorexia nervosa treatment: a systematic review and qualitative synthesis

Objective: To systematically review the literature on clinicians’ and patients’ experiences of supported mealtimes in the treatment of anorexia nervosa. Method: This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (CRD42022372565). PsycINFO, MEDLINE, and Embase were searched up to the 20th of November 2023 for qualitative articles investigating the perspectives of healthcare professionals and patients on clinician-supported meals across all clinical settings. Data were analysed using thematic synthesis. The Critical Appraisal Skills Program was used to evaluate the quality of selected studies. Results: This review comprised of 26 studies; eight concerned with the perspectives of clinician experiences only, 16 addressing patients’ views and two papers exploring the experiences of both groups. Experiences of both groups were generally negative; three overlapping themes were identified: lack of consistency in care provided, high levels of negative emotions and an uncomfortable power dynamic. Conclusions: This review suggests that supported mealtimes are experienced more positively by patients when rules are clear and consistently enforced, and when clinicians make informal conversation and supportive comments. Our findings highlight the need for best practice guidelines and clinician training to improve the delivery of supported mealtimes. Such guidelines and training should be coproduced in collaboration with patients and carers.