Healthcare professionals' perspectives on the role of dietitians within multidisciplinary head and neck cancer teams: A qualitative multi-site study.

AIM: Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes. Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals. METHODS: This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines." CONCLUSIONS: While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study.

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

The experience of nutritional care according to patients with head and neck cancer involved with a combined dietitian, specialist nurse and speech pathologist clinic in a regional Australia: a qualitative longitudinal study.

PURPOSE: Malnutrition is a co-morbidity of head and neck cancer (HNC) that has negative consequences for patients. Evidence-based guidelines (EBGs) provide recommendations to prevent and manage malnutrition. A clinic that combines the services of a dietitian, specialist oncology nurse and speech pathologist may promote the implementation of nutritional EBGs in regional Australia. This study aimed to explore the nutritional care experience that patients with HNC had in this setting. METHODS: A qualitative longitudinal study collected data via semi-structured interviews with HNC patients who were treated in one regional cancer care network in Australia. Interviews were conducted at key points in their HNC journey from diagnosis to 4 months post-radiotherapy. Data was analysed using a grounded theory approach. RESULTS: Ten participants completed a total of thirty-six interviews. The findings were grouped into four categories: "preparing for nutritional challenges", "multidisciplinary care directed by patient needs", "the battle to eat", and "incongruence between patient values and nutritional priorities". CONCLUSION: These findings highlight the nutritional burden associated with HNC and barriers to patients accepting nutritional support from healthcare professionals. Information provided by doctors and nurses prior to treatment may help patients prepare for the nutritional challenges ahead and accept support from dietitians. Furthermore, clinics that promote continuity through treatment and allow dietitians to lead aspects of nutritional care, in collaboration with nurses, speech pathologists and doctors, may also enhance the nutritional care experience. More qualitative research within HNC teams would provide further insight on enhancing the implementation of nutritional EBGs to improve outcomes for these patients.

Healthcare Professionals' Perceptions of Feeding Tube Practices for Patients With Head and Neck Cancer Across 4 International Radiation Oncology Departments.

BACKGROUND: Malnutrition is common and debilitating among patients with head and neck cancer (HNC). A feeding tube (FT) can help to minimize this. However, there is debate on FT use, including whether a reactive nasogastric tube (NGT) or prophylactic gastrostomy tube (PGT) approach is best. This study aimed to explore interdisciplinary healthcare professionals' perspectives of FT practices for patients with HNC, across 4 radiation departments in Australia and the United States. METHODS: Healthcare professionals involved in the clinical care of patients undergoing radiotherapy for HNC were recruited from 2 radiation-oncology departments in Australia and 2 in the United States. Individual interviews were recorded and analyzed using a grounded theory approach. RESULTS: Seventeen radiation oncologists, 12 nurses, 11 dietitians, and 6 speech pathologists participated. "Perspectives of FTs for patients with HNC" comprised 4 categories: a valued support, more individualized, no universal practice, and PGT vs NGT. "Placement considerations" comprised 6 patient categories (planned treatment, tumor characteristics, nutrition and swallow status, tube-dependence risk, psychosocial status, and patient preferences) and 4 service-structure categories (dietetic access, speech-pathology access, interdisciplinary collaboration, and nutrition-support infrastructure). CONCLUSION: Although the targeted use of FTs was valued by healthcare professionals, several patient and service-structure factors may influence whether the PGT or reactive NGT approach is perceived to be more efficacious. Further research is needed to explore patient preferences, tube dependence, interdisciplinary collaboration, and department infrastructure to promote consistent evidence-based and patient-centered FT practices.

The patient experience of having a feeding tube during treatment for head and neck cancer: A systematic literature review.

BACKGROUND AND AIMS: Patients undergoing treatment for head and neck cancer (HNC) can experience severe weight loss, malnutrition and dehydration which can cause treatment delays. Enteral feeding can reduce the risk of these. However, the use of feeding tubes (FT), including FT type and placement timing is debated. This paper aimed to describe the patient experience of having a FT during treatment for HNC. METHODS: A systematic literature review of qualitative studies was undertaken in the databases Web of Science, CINAHL, Scopus and Science Direct using Prospero and Joanna Brigg's Institute guidelines. RESULTS: Nine studies were included providing the perspectives of 159 patients who had a FT during treatment for HNC. 150 findings and 183 illustrations which were primarily patient quotes were extracted. Analysis resulted in 42 categories from which nine synthesized findings were produced. These are summarized as: initial reluctance and fear; different understandings and expectations; individual preferences around choice; physical discomfort; restrictions to social life and daily living; new challenges and responsibilities; gradual acceptance; a challenging but rewarding transition process; and overall a worthwhile decision. CONCLUSION: These findings highlight the nutrition-related burden patients with HNC experience and support the need for interdisciplinary healthcare teams that integrate dietetics and speech pathology. This review supports individualized approaches to FT placement decisions. Further well-designed studies are needed to better understand patient and cancer-service structural factors that may influence the experience of having a FT, to ensure that decisions are evidence-based and patient-centered for best outcomes.