| Summary: | In the acute stages of stroke where the patient experiences dysphagia or reduced levels of consciousness, clinicians make decisions on how a patient's food and fluid needs will be met. These decisions include whether the patient should take oral diet, or whether nutrition should be administered via a Nasogastric (NG) or Percutaneous Endoscopic Gastrostomy (PEG) tube. This qualitative study investigates the process by which clinicians make decisions over the timing and mode of nutrition or hydration interventions available to them. Data were collected from twenty patient participants and twenty-four clinicians from two NHS Trusts. The patient data comprised both clinical case note data and observational data taken from clinical discussions on the ward during their admission. In-depth interviews were undertaken with clinicians to explore their experiences and views on decision making for nutrition and hydration. The data were analysed to generate substantive theory following the principles of grounded theory. The findings suggest that the decision making process follows a normative pathway of 'not to feed' the patient which is based on three key beliefs. These were that; nutrition and hydration were viewed as distinct and different interventions, with nutrition not being considered essential to recovery after stroke; the risk of pulmonary aspiration was perceived to outweigh the benefits of providing nutrition; and, that nutritional interventions could prolong a poor Quality of Life for a patient. Deviation from this normative pathway by clinicians was influenced by four key themes; views about the patient's prognosis; beliefs about the nutrition and hydration interventions available; perceived responsibilities of those involved; and, personal conscience issues. The findings from the study are discussed in the context of clinical practice and the implications for future research
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