A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada.

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n = 111 dietitians, n = 72 physicians, n = 42 allied HCPs), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n = 142/220; dietitians: 88% vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n = 117) by dietitians (n = 94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n = 121/212), time (40%, n = 84/212) and support from others (38%, n = 80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

Prehabilitation as Novel Paradigm Shift in Cancer Care.

OBJECTIVES: Prehabilitation aims to optimize patients' preoperative risk factors while waiting for surgery. The preoperative period is a salient time to modify health behaviors with the aim to mitigate the stress of surgery and facilitate the recovery process. DATA SOURCES: This is a narrative review of scientific evidence and published reports on aspects of prehabilitation for patients with cancer. CONCLUSION: While the prehabilitation team identifies the health issues ahead of the surgical date, patients become engaged in improving their health. This demands a shift in how the perioperative care is organized, taking into consideration the active role of the patient and the multidisciplinary team approach. IMPLICATIONS FOR NURSING PRACTICE: While the patient with cancer is at the center of the perioperative care, the prehabilitation multidisciplinary team, which includes the perioperative physician, the physiotherapist/kinesiologist/exercise physiologist, the dietician, the psychologist, and the specialist nurse, works together with the surgeon and the oncologist to screen, assess, and plan a personalized intervention. In this context, the specialist nurse can collaborate with the team in identifying those patients at risk who might benefit from the prehabilitation program (eg, frail, older, malnourished, smoker, with many comorbidities) . The specialist nurse will be able to coordinate the time of visits, liaise with the caregivers, identify barriers, and participate in decision-making activities.