{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:19:11Z","timestamp":1787797151838,"version":"build-2784847793"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":44,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Congenital Duodenal Obstruction (CDO) is a rare birth defect requiring post-surgical nutritional support, using parenteral nutrition (PN), trans-anastomotic tubes (TAT), or both. TATs offer health and cost benefits, but widespread variation in practice exists: most infants receive PN, and few are fed solely via a TAT. This study aimed to understand how and why clinicians make post-operative feeding decisions for infants with CDO focusing on TATs, and to identify requirements for practice change to increase TAT use and reduce PN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Clinicians working in paediatrics in the UK\u2019s National Health Service took part in online interviews (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200925) and three subsequent focus groups (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200917 participants). Interviews were coded using thematic analysis to generate themes to understand current feeding practices. Interviewees were sampled purposively to attempt to achieve diversity across workplace location, clinical role, and TAT practice, resulting in participants from 13 different centres and a near-equal distribution of TAT usage: 9 who always or often use TATs, 8 who sometimes use them, and 8 who rarely or never do. Focus groups were used to refine and prioritise interventions for increasing TAT usage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Interview analysis resulted in four interconnected themes, covering confidence and skills, research scepticism, perceived risks, and organisational inertia. Clinicians requested research demonstrating TATs\u2019 safety and effectiveness that largely already exists in the published literature, suggesting the primary barrier to TAT use is a lack of knowledge translation rather than a lack of evidence. Proposed interventions centred on dissemination of existing research and TAT-specific multidisciplinary education and training.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Clinicians\u2019 reluctance to use TATs is multifaceted, rooted in experiential, organisational, and knowledge-based barriers. Increasing TAT usage does not necessarily require new research: dissemination of existing evidence alongside standardised, multidisciplinary education and care pathways should be the immediate priority.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-026-07310-7","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:35:56Z","timestamp":1784025356000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinicians\u2019 post-operative feeding decisions for infants with congenital duodenal obstruction and trans-anastomotic tube usage: a qualitative interview and focus group study"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1242-9010","authenticated-orcid":false,"given":"Alexandra","family":"Jager","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Turnbull","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"John Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nigel J","family":"Hall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"7310_CR1","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1136\/archdischild-2023-325988","volume":"109","author":"GS Bethell","year":"2024","unstructured":"Bethell GS, Neville JJ, Johnson MJ, Turnbull J, Hall NJ. Congenital duodenal obstruction repair with and without transanastomotic tube feeding: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed. 2024;109:182\u20138. https:\/\/doi.org\/10.1136\/archdischild-2023-325988.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"2","key":"7310_CR2","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1136\/archdischild-2019-317085","volume":"105","author":"GS Bethell","year":"2020","unstructured":"Bethell GS, Long AM, Knight M, Hall NJ, Baps C. Congenital duodenal obstruction in the UK: a population-based study. Arch Dis Child Fetal Neonatal Ed. 2020;105(2):178\u201383. https:\/\/doi.org\/10.1136\/archdischild-2019-317085.","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"9","key":"7310_CR3","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1093\/bjs\/znad040","volume":"110","author":"GS Bethell","year":"2023","unstructured":"Bethell GS, Long A-M, Knight M, Hall NJ, Baps C. Factors associated with outcomes in congenital duodenal obstruction: population-based study. Brit J Surg. 2023;110(9):1053\u20136. https:\/\/doi.org\/10.1093\/bjs\/znad040.","journal-title":"Brit J Surg"},{"issue":"3","key":"7310_CR4","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/s00383-021-05053-3","volume":"38","author":"M Treider","year":"2022","unstructured":"Treider M, Engebretsen AH, Skari H, Bjornland K. Is postoperative transanastomotic feeding beneficial in neonates with congenital duodenal obstruction? Pediatr Surg Int. 2022;38(3):479\u201384. https:\/\/doi.org\/10.1007\/s00383-021-05053-3.","journal-title":"Pediatr Surg Int"},{"issue":"4","key":"7310_CR5","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1007\/s00383-018-4411-5","volume":"35","author":"R Harwood","year":"2019","unstructured":"Harwood R, Horwood F, Tafilaj V, Craigie RJ. Transanastomotic tubes reduce the cost of nutritional support in neonates with congenital duodenal obstruction. Pediatr Surg Int. 2019;35(4):457\u201361. https:\/\/doi.org\/10.1007\/s00383-018-4411-5.","journal-title":"Pediatr Surg Int"},{"issue":"9","key":"7310_CR6","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/j.jpedsurg.2022.01.049","volume":"57","author":"R Cresner","year":"2022","unstructured":"Cresner R, Neville JJ, Drewett M, Hall NJ, Darwish AA. Use of trans-anastomotic tubes in congenital duodenal obstruction. J Pediatr Surg. 2022;57(9):45\u20138. https:\/\/doi.org\/10.1016\/j.jpedsurg.2022.01.049.","journal-title":"J Pediatr Surg"},{"key":"7310_CR7","doi-asserted-by":"publisher","unstructured":"Jager A, Turnbull J, Johnson M, Hall N. Exploring the current usage of and attitudes towards transanastomotic tube (TAT) feeding in infants born with duodenal atresia: a survey of practice in the UK. BMJ Paediatr Open. 2025;9(1). https:\/\/doi.org\/10.1136\/bmjpo-2024-003267.","DOI":"10.1136\/bmjpo-2024-003267"},{"issue":"1","key":"7310_CR8","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1186\/s12913-017-2031-8","volume":"17","author":"M Sekhon","year":"2017","unstructured":"Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):88. https:\/\/doi.org\/10.1186\/s12913-017-2031-8.","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"7310_CR9","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1111\/bjhp.12677","volume":"28","author":"C Paynter","year":"2023","unstructured":"Paynter C, McDonald C, Story D, Francis JJ. Application of the theoretical framework of acceptability in a surgical setting: Theoretical and methodological insights. Br J Health Psychol. 2023;28(4):1153\u201368. https:\/\/doi.org\/10.1111\/bjhp.12677.","journal-title":"Br J Health Psychol"},{"issue":"1","key":"7310_CR10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1177\/1525822x05282260","volume":"18","author":"NV Ivankova","year":"2006","unstructured":"Ivankova NV, Creswell JW, Stick SL. Using Mixed-Methods Sequential Explanatory Design: From Theory to Practice. Field Methods. 2006;18(1):3\u201320. https:\/\/doi.org\/10.1177\/1525822x05282260.","journal-title":"Field Methods"},{"issue":"1","key":"7310_CR11","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1186\/s12913-018-3801-7","volume":"18","author":"RL Jessup","year":"2018","unstructured":"Jessup RL, Osborne RH, Buchbinder R, Beauchamp A. Using co-design to develop interventions to address health literacy needs in a hospitalised population. BMC Health Serv Res. 2018;18(1):989. https:\/\/doi.org\/10.1186\/s12913-018-3801-7.","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"7310_CR12","doi-asserted-by":"publisher","first-page":"e083495","DOI":"10.1136\/bmjopen-2023-083495","volume":"14","author":"M Woodhouse","year":"2024","unstructured":"Woodhouse M, Cowdell F, Roddis J, Devrell A, Oakley K, Dyson J. Theoretically informed codesign of a tailored intervention to support pressure ulcer prevention behaviours by older people living in their own homes in the UK and their lay carers: an intervention codesign study (C-PrUP). BMJ Open. 2024;14(11):e083495. https:\/\/doi.org\/10.1136\/bmjopen-2023-083495.","journal-title":"BMJ Open"},{"issue":"6","key":"7310_CR13","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","journal-title":"Int J Qual Health Care"},{"issue":"2","key":"7310_CR14","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa.","journal-title":"Qual Res Psychol"},{"issue":"3","key":"7310_CR15","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1007\/s11135-021-01182-y","volume":"56","author":"D Byrne","year":"2021","unstructured":"Byrne D. A worked example of Braun and Clarke\u2019s approach to reflexive thematic analysis. Qual Quant. 2021;56(3):1391\u2013412. https:\/\/doi.org\/10.1007\/s11135-021-01182-y.","journal-title":"Qual Quant"},{"key":"7310_CR16","unstructured":"Lumivero. NVivo (Version 13). (https:\/\/lumivero.com\/products\/nvivo\/)"},{"issue":"5","key":"7310_CR17","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1136\/jech-2015-205952","volume":"70","author":"D Wight","year":"2016","unstructured":"Wight D, Wimbush E, Jepson R, Doi L. Six steps in quality intervention development (6SQuID). J Epidemiol Community Health. 2016;70(5):520\u20135. https:\/\/doi.org\/10.1136\/jech-2015-205952.","journal-title":"J Epidemiol Community Health"},{"issue":"8","key":"7310_CR18","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00383-011-2896-2","volume":"27","author":"N Hall","year":"2011","unstructured":"Hall N, Drewett M, Wheeler R, Griffiths D, Kitteringham L, Burge D. Trans-anastomotic tubes reduce the need for central venous access and parenteral nutrition in infants with congenital duodenal obstruction. Pediatr Surg Int. 2011;27(8):851\u20135.","journal-title":"Pediatr Surg Int"},{"issue":"11","key":"7310_CR19","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1007\/s00383-021-04954-7","volume":"37","author":"N Biradar","year":"2021","unstructured":"Biradar N, Gera P, Rao S. Trans-anastomotic tube feeding in the management of congenital duodenal obstruction: a systematic review and meta-analysis. Pediatr Surg Int. 2021;37(11):1489\u201398. https:\/\/doi.org\/10.1007\/s00383-021-04954-7.","journal-title":"Pediatr Surg Int"},{"issue":"5","key":"7310_CR20","first-page":"S38","volume":"104","author":"D Aroonsaeng","year":"2021","unstructured":"Aroonsaeng D, Teeraratkul S, Molagool S, Thirapattaraphan C. Role of transanastomotic feeding tube versus early gastric feeding in postoperative duodenal surgery. J Med Assoc Thai. 2021;104(5):S38\u201341.","journal-title":"J Med Assoc Thai"},{"issue":"03","key":"7310_CR21","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1055\/s-2002-32727","volume":"12","author":"E Arnbj\u00f6rnsson","year":"2002","unstructured":"Arnbj\u00f6rnsson E, Larsson M, Finkel Y, Karpe B. Transanastomotic feeding tube after an operation for duodenal atresia. Eur J Pediatr Surg. 2002;12(03):159\u201362.","journal-title":"Eur J Pediatr Surg"},{"issue":"6","key":"7310_CR22","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1111\/ans.12180","volume":"83","author":"W Crebbin","year":"2013","unstructured":"Crebbin W, Beasley SW, Watters DA. Clinical decision making: how surgeons do it. ANZ J Surg. 2013;83(6):422\u20138. https:\/\/doi.org\/10.1111\/ans.12180.","journal-title":"ANZ J Surg"},{"key":"7310_CR23","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/978-3-031-67391-7_4","volume-title":"Surgical Decision-Making: Evidence and Beyond","author":"R Latifi","year":"2024","unstructured":"Latifi R, Smiley A. The Anatomy of the Surgeon\u2019s Decision-Making. In: Latifi R, editor. Surgical Decision-Making: Evidence and Beyond. Cham: Springer Nature Switzerland; 2024. pp. 31\u20139."}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-026-07310-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07310-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-026-07310-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T02:16:37Z","timestamp":1787796997000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12887-026-07310-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["7310"],"URL":"https:\/\/doi.org\/10.1186\/s12887-026-07310-7","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]},"assertion":[{"value":"24 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Favourable ethical approval was given by the University of Southampton Faculty of Medicine Research Ethics Committee (ERGO ID number: 78214).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Participants gave informed consent (interviewees: written or verbal, focus group participants: written only) prior to participation.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"807"}}