Exploring dietitians' practice and perspectives on the role of dietary patterns during cancer treatment: A qualitative study.

BACKGROUND: Dietitians are nutrition professionals equipped with specialised skills required to prevent and treat malnutrition in cancer. Optimisation of dietary intake is recommended as the primary nutrition strategy for the treatment of cancer-related malnutrition. However, it is unclear whether dietary patterns, described as the combination, quantity, and frequency of food consumption, are considered. This study examined dietitians' current food-based management of malnutrition; explored dietitians' awareness of dietary patterns and assessed barriers and enablers to the use of dietary patterns in clinical practice. METHODS: This qualitative study consisted of semi-structured interviews with oncology dietitians. Dietitians were recruited through national nutrition societies, social media, and professional networks. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis. RESULTS: Fourteen oncology dietitians from across four Australian states and territories participated. Three themes were identified: (i) principles to guide nutritional care, (ii) dietary patterns as a gap in knowledge and practice, and (iii) opportunities for better care with systems as both a barrier and enabler. Dietetic practice was food-focussed, encouraging energy and protein-rich foods consistent with nutrient-focussed evidence-based guidelines. Dietitians encouraged one of two nutrition-related approaches, either encouraging intake of 'any tolerated food' or 'foods supportive on longer-term health'. Dietitians were generally unaware of dietary patterns and questioned their relevance in certain clinical situations. A multidisciplinary team approach, adequate food service and dissemination of dietary patterns research and education were identified as opportunities for better patient care. CONCLUSIONS: Recommendations for the treatment of malnutrition vary between oncology dietitians and uncertainty exists regarding dietary patterns and their relevance in clinical practice. Further exploration into the role of dietary patterns to treat cancer-related malnutrition and education for dietitians are required prior to implementation of a dietary patterns approach into clinical practice.

A survey regarding the role of UK dietitians in spiritual care.

BACKGROUND: Users of dietetic services have unmet spiritual needs, although no study has yet explored dietitians' opinion, perceptions or experience of assessing spiritual needs and delivering spiritual care in clinical practice. METHODS: A cross-sectional survey assessed the role of UK dietitians in spiritual care. RESULTS: Thirty-seven practicing dietitians, with experience ranging from newly qualified to over 21 years of practice, took part in the survey containing open and closed questions. Almost half (49%) of dietitians said they always conducted spiritual assessments and most (57%) said they sometimes made a referral for spiritual concerns. When spiritual issues arose, dietitians were highly likely to listen well (score 4.6 out of 5) and encourage service users in their own (the service user) spiritual or religious practices (score 4 out of 5). However, the likelihood of taking the initiative and enquiring about religious and spiritual issues was lower (score <3 out of 5) in all areas of practice including end of life care. This may have been because confidence around spiritual care was also low (score 4.7 out of 10), uncertainty was high (score >3.5 out of 5) and there was a strong desire to receive training (>4 out of 5). Qualitative responses expanded further on these results suggesting that there was positive "intention" to provide spiritual care, but lack of training was a significant barrier (qualitative theme: "inadequacies"). The recognition of necessity but uncertainty of how to meet spiritual needs was also shown through qualitative findings to be a source of "emotional labour", particularly where there were conflicting beliefs between a dietitian and service user. CONCLUSIONS: Although limited by a small sample size, these results provide new knowledge that spiritual care is considered an important part of the dietitians' role and that this is the case regardless of the dietitians own spiritual identity or religion. Dietitians would value training in spiritual care so that they can support service user needs more readily and confidently.

Generative Artificial Intelligence as a Tool for Teaching Communication in Nutrition and Dietetics Education-A Novel Education Innovation.

Although effective communication is fundamental to nutrition and dietetics practice, providing novice practitioners with efficacious training remains a challenge. Traditionally, human simulated patients have been utilised in health professions training, however their use and development can be cost and time prohibitive. Presented here is a platform the authors have created that allows students to interact with virtual simulated patients to practise and develop their communication skills. Leveraging the structured incorporation of large language models, it is designed by pedagogical content experts and comprises individual cases based on curricula and student needs. It is targeted towards the practice of rapport building, asking of difficult questions, paraphrasing and mistake making, all of which are essential to learning. Students appreciate the individualised and immediate feedback based on validated communication tools that encourage self-reflection and improvement. Early trials have shown students are enthusiastic about this platform, however further investigations are required to determine its impact as an experiential communication skills tool. This platform harnesses the power of artificial intelligence to bridge the gap between theory and practice in communication skills training, requiring significantly reduced costs and resources than traditional simulated patient encounters.

Fruit and Vegetable Intake, Food Security, Barriers to Healthy Eating, and Empowerment among Dietetic Interns and Physician Assistant Interns: A Cross-Sectional Pilot Study.

Students are required to complete supervised practice hours prior to becoming Registered Dietitians and Physician Assistants. Research suggests that environmental and social factors affect dietetic interns' diets during their internship, although these factors have not been studied among physician assistant interns. This cross-sectional study utilized an online survey to compare dietetic interns' (n = 81) and physician assistant interns' (n = 79) fruit and vegetable intake, food security, barriers to healthy eating, and empowerment for making healthy dietary choices during an internship. Differences were assessed via independent t-tests and chi-square distributions. The significance was set at p < 0.05. Dietetic interns had a higher vegetable intake (p = 0.002) while physician assistant interns had higher rates of food insecurity (p = 0.040). Dietetic interns reported a greater impact on their dietary choices due to mental fatigue (p = 0.006), while physician assistant interns' dietary choices were more heavily impacted by peer influence, interactions with patients, and interactions with preceptors (p < 0.05). There was not a group difference in overall empowerment (p = 0.157), although both groups rated empowerment for asking for help with food and nutrition challenges the lowest of the empowerment sub-items. Addressing interns' unique needs may support students' educational success and wellbeing once they are professionals, promote a diverse workforce, and ensure optimal care for patients.

Nutrition employability and graduate readiness: The Australian Working in Nutrition study.

BACKGROUND: Nutrition science graduates contribute to the nutrition workforce by bringing specialist knowledge and skills needed to address future food challenges. This study aims to provide a snapshot of the current employment landscape for nutrition science graduates in Australia and how well their degrees prepare them for employment. METHOD: A cross-sectional survey of Australian tertiary nutrition graduates was conducted to explore tertiary training, employment pathways and their perceived preparedness for practice. RESULTS: This study included a final sample of 119 graduates from 17 Australian tertiary institutions. Almost two-thirds of respondents had completed further training. Most graduates (77%, n = 91) had worked in a food, nutrition science or health-related role after their degree; the most frequently cited employment settings were government or public health organisations; research, not-for-profit or nongovernment organisations; and the food industry. Work-integrated learning was identified as a key predictor of graduates working in a role that differed from their expectations as a student. The skill categories developed during nutrition training that were most valued in the workplace included nutrition and scientific knowledge, and professional and communication skills. CONCLUSIONS: This study offers first insights into the current employment landscape for nutrition graduates across Australia. Findings show that current nutrition science professionals are highly qualified and prepared to navigate the evolving demands of nutrition practice. Regular review of graduate employment will inform nutrition science curriculum to enable graduates to be well equipped in the face of dynamic practice settings.

The role of social media in the professional sphere of Finnish registered dietitians.

BACKGROUND: With the widespread use of social media, understanding how healthcare professionals, such as dietitians, utilise these platforms for their work has gained interest. The aim of the current study was to describe how Finnish registered dietitians utilise various social media channels for professional purposes. The study also investigated the perceived social media skills of dietitians. METHODS: A cross-sectional study was conducted using an online survey administered between December 2022 and February 2023. The participants were 107 Finnish registered dietitians who held a master's degree suitable for the profession. The Fisher's exact test was employed for categorical variables, whereas the Kruskal-Wallis test was used for ordinal variables with multiple groups. RESULTS: Out of the 107 participants, 62 (58%) reported using social media for professional purposes. The primary purposes across various social media channels were interaction with colleagues (80%) on Facebook, networking with professionals from other fields (86%) on LinkedIn and general monitoring of the field on Instagram (91%), Twitter (77%) and YouTube (58%). Dietitians' perceived social media skills were found to have a statistically significant relationship with age (p < 0.05) for all channels, except Twitter. CONCLUSIONS: The findings suggest that Finnish dietitians predominantly utilise social media for passive monitoring of the field, rather than actively sharing content with the public. Professional communication tends to take place within their own professional groups. Incorporating social media use into the official job description could serve as an encouraging factor to enhance the professional utilisation of social media among dietitians.

Global Leadership Initiative on Malnutrition (GLIM) for the diagnosis of malnutrition - a framework for consistent dietetic practice.

Malnutrition is an alarming and ongoing healthcare problem globally. Malnutrition has a negative impact on the individual patient, leading to poorer clinical outcomes and increased mortality, but also poses an economic burden on society. Proper identification and diagnostics are prerequisites for initiation of treatment. In 2019, the Global Leadership Initiative on Malnutrition, a consensus-based global framework to uniformly diagnose malnutrition across populations, healthcare settings, and countries was published. Identifying and treating malnutrition is an interdisciplinary team effort. Nonetheless, the nutrition and dietetics profession is specifically trained for diagnosing and treating nutrition(-related) conditions, and therefore has a key role in the interdisciplinary team in implementing the GLIM framework in clinical practice. For the nutrition and dietetics profession, GLIM offers a great opportunity for moving both the scientific and clinical knowledge of malnutrition management forward. While the GLIM framework has been extensively studied since its launch, various knowledge gaps still remain. For the nutrition and dietetics profession, these knowledge gaps mainly relate to the GLIM implementation process, to the role of GLIM in relation to the nutrition care process, and to treatment strategies for various nutrition-related conditions. In this opinion paper, we aimed to describe the rationale for implementing the GLIM framework in clinical dietetic practice, and propose a research agenda based on knowledge gaps regarding GLIM in relation to nutrition care from a dietetic point of view.

Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study.

BACKGROUND: The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment. OBJECTIVES: This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified. METHODS: A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes. RESULTS: After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake. CONCLUSIONS: Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic. CLINICALTRIALS: gov/ct2/show/NCT03928548).

Obesity and Nutrigenetics Testing: New Insights.

BACKGROUND: Obesity results from interactions between environmental factors, lifestyle, and genetics. In this scenario, nutritional genomics and nutrigenetic tests stand out, with the promise of helping patients avoid or treat obesity. This narrative review investigates whether nutrigenetic tests may help to prevent or treat obesity. Scientific studies in PubMed Science Direct were reviewed, focusing on using nutrigenetic tests in obesity. The work showed that few studies address the use of tools in obesity. However, most of the studies listed reported their beneficial effects in weight loss. Ethical conflicts were also discussed, as in most countries, there are no regulations to standardize these tools, and there needs to be more scientific knowledge for health professionals who interpret them. International Societies, such as the Academy of Nutrition and Dietetics and the Brazilian Association for the Study of Obesity and Metabolic Syndrome, do not recommend nutrigenetic tests to prevent or treat obesity, especially in isolation. Advancing nutrigenetics depends on strengthening three pillars: regulation between countries, scientific evidence with clinical validity, and professional training.

The Role of the Dietitian within Family Therapy for Anorexia Nervosa (FT-AN): A Reflexive Thematic Analysis of Child and Adolescent Eating Disorder Clinician Perspectives.

BACKGROUND: Despite dietitians being important members of the multidisciplinary team delivering family therapy for anorexia nervosa (FT-AN), their specific responsibilities and roles are unclear and their involvement in the treatment can be a contentious issue. METHODOLOGY: Clinicians (n = 20) experienced in the delivery of FT-AN who were working at a specialist child and adolescent eating disorder service responded to an online survey about their experience of including a dietitian in FT-AN and how they understand the role. Both categorical and open-ended questions were used. Reflexive thematic analysis was used to analyse the qualitative free-text responses of clinician perspectives on the role of the dietitian in FT-AN. RESULTS: All clinicians agreed that dietetics had a role within FT-AN and most frequently sought dietetic involvement in the early phases of FT-AN. Reflexive thematic analysis of responses identified three main themes. These were (1) collaboration is key, (2) confidence as a core consideration and (3) case-by-case approach. These themes evidenced the role of the dietitian within FT-AN and highlighted both the benefits and concerns of this involvement. CONCLUSIONS: This study demonstrated that dietitians can take a core role as collaborators within therapy-led teams that facilitate joint working and sharing of expertise. However, dietetic input should be considered on a case-by-case basis, given its potential for creating an over-focus on nutrition and potentially diminishing parental confidence in feeding. When indicated for selected cases, nutritional counselling should be offered in joint sessions with the therapist rather than separately. The findings of the study were limited by the small sample size of participants recruited from a single centre and heterogeneity in the professional background of respondents. Although the integration of dietetics within the multidisciplinary team and the ability of dietitians to individualise patient care can enhance FT-AN treatment, potential benefits and disbenefits should be considered for each case.

Didactic program in dietetics (DPD) students' experiences with pandemic learning and expectations for their future education: a descriptive study through a systems lens.

BACKGROUND: The systems approach has been used to evaluate higher education and explores inputs, transformation process, and outputs of a system that is also influenced by environmental factors such as COVID-19. The COVID-19 pandemic shifted many college students to different learning modes, changing their university experience. This study evaluated dietetics students' education experiences and characteristics in the latter period (spring 2022) of the COVID-19 pandemic using the systems approach. METHODS: Researchers developed and distributed an electronic survey to all 215 US-based Didactic Program in Dietetics (DPD) directors during March to May 2022 to forward to their students. Researchers calculated descriptive statistics for variables related to inputs, transformation process, and outputs in the systems approach. RESULTS: Respondents (n = 341) represented 51 DPDs in 31 states in the United States. Overall, DPD students (88.5%) were mostly or very satisfied with their choice of majoring in dietetics. Most (84.0%) planned to earn the RDN credential. Nearly half (46.9%) of DPD students were somewhat or extremely concerned about their readiness to continue their dietetics education path due to the pandemic-related learning conditions. Most students (43.6%) reported dissatisfaction with asynchronous remote instruction in laboratory courses. DPD students' GPAs remained consistent within the range of 3.75-4.0 from Fall 2019 (43.2%) to Spring 2022 (44.5%). The most important expectations of professors moving forward were to communicate effectively (97.3%), employ cultural humility (93.8%), eliminate discrimination in the classroom (93.6%), provide lecture slides (89.7%), and be flexible and accommodating (88.7%). CONCLUSIONS: DPD students emerged from COVID-19 with new perspectives and expectations for their university learning experience. Future research should explore the perspectives of DI directors, preceptors, and employers of COVID-19 era DPD graduates.