Experiences of healthcare practitioners providing nutrition care to people with cancer in New Zealand: A qualitative study.

Aim: To explore the perspectives and experiences of healthcare practitioners in providing nutrition care to people with cancer in New Zealand. Methods: Semi-structured interviews were conducted with 16 New Zealand healthcare professionals (HCPs) practicing in specialist secondary and tertiary cancer care (both public and private) who had previously completed an online survey about nutrition in cancer care. Interviews were recorded and transcribed verbatim, and thematic analysis was undertaken. Results: Participants identified nutrition as important in cancer care, from diagnosis to survivorship, in order to maximise recovery and ongoing health. While participants reported that the best person to provide high-quality individualised nutrition care is a dietitian, other HCPs also have a role in nutrition care. Limited nutrition care is currently available, especially for those in rural areas, which impacts health and equity in cancer care. Participants identified a need for increased dietitian capacity in the workforce as well as a need for nutrition resources that were accessible and appropriate. Conclusion: The perspective of participants was that more must be done to provide nutrition care as part of cancer care in New Zealand to improve health and wellbeing among people with cancer.

Nutrition support in oncology care in Aotearoa New Zealand: current practice, and where to from here?

AIM: This research sought to identify and understand what nutrition-related information and support is available to people undergoing cancer treatment. We also sought the views on nutrition for cancer among providers of cancer care/support, and barriers/enablers to the provision of nutrition information/support. METHOD: Data were collected using online surveys with New Zealand-based healthcare practitioners and support workers. Descriptive analysis was undertaken. Open-ended questions were analysed for explanatory content to help us interpret and understand the results. RESULTS: Most healthcare practitioners and support workers viewed nutrition as at least moderately important (for cancer recovery, patient wellbeing and preventing cancer recurrence) and believed nutrition information/support should be provided to cancer patients. However, nutrition information and support were not widely available through oncology practices and cancer support services. The main barriers to the provision of nutrition information and support (including access to dietitian appointments) were insufficient funding and lack of time/staff capacity. Additional barriers included a lack of access to evidence-based information and dietary expertise. CONCLUSION: Nutrition information and support needs to be more widely available and standardised across New Zealand's oncology services. Ideally this would include general introductory information about nutrition (eg, World Cancer Research Fund recommendations) from all healthcare practitioners and more detailed tailored advice (and ongoing support where needed) from dietitians.

Food, nutrition and cancer: perspectives and experiences of New Zealand cancer survivors.

AIM: This research sought to understand and describe cancer survivors' perspectives and post-diagnosis experiences of food and nutrition, with a particular focus on barriers to healthy eating, health equity, and Maori and Pacific perspectives. METHOD: Data were collected using semi-structured interviews with cancer survivors from three different ethnic groups (Maori, Pacific Peoples, and New Zealand European). Thematic analysis was undertaken to identify both similar and contrasting experiences and perspectives in relation to topics of interest. Data analysis also sought to identify any trends indicating differences between ethnic groups. RESULTS: Limited awareness of the role nutrition has in cancer recovery or prevention, combined with little or no access to nutrition advice/support, meant that healthy dietary change was not a focus for some cancer survivors in this study, whereas others invested considerable time and money accessing nutrition information and support outside of cancer care services. Financial limitations (eg, cost of healthy food and low income) and lack of practical support were also important barriers to post-diagnosis healthy eating. CONCLUSION: There is a need for more widely available cancer-specific nutrition advice and support in New Zealand. Interventions to address financial barriers and increase access to cancer-related nutrition advice and support have the potential to improve cancer outcomes and reduce inequities in cancer outcomes.

Comparison of 24-h Diet Records, 24-h Urine, and Duplicate Diets for Estimating Dietary Intakes of Potassium, Sodium, and Iodine in Children.

Accurately estimating nutrient intake can be challenging, yet it is important for informing policy. This cross-sectional validation study compared the use of three methods for estimating the intake of sodium, potassium, and iodine in children aged 9-11 years in New Zealand. Over the same 24 hour period, participants collected duplicate diets (n = 37), weighed food records (n = 84), and 24 hour urine samples (n = 82). Important differences were found between dietary estimates of sodium, potassium, and iodine using the three methods of dietary assessment, suggesting that different methods of assessment have specific limitations for the measurement of these nutrients in children. Bland Altman plots show relatively wide limits of agreement for all measures and nutrients. These results support the World Health Organization's (WHOs) recommendations to use urinary assessment to measure population sodium and iodine intake, while dietary assessment appears to be more accurate for estimating potassium intake. Compared to reference values, our results suggest that the children in this study consume inadequate iodine, inadequate potassium, and excess dietary sodium. Public health measures to reduce sodium intake, increase intake of fruit and vegetables, and iodine-rich foods are warranted in New Zealand.

The Role of Personality in Daily Food Allergy Experiences.

Food allergies present numerous challenges to coping in everyday life. Even simple things like planning a lunch with a friend can be stressful for people with food allergies. But are some people more adversely impacted by having a food allergy than other people? This paper addressed this question by investigating whether individual differences in the Big Five personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) are related to food allergy-related problems in everyday life among adults with food allergies. Participants were 108 adults (85% female; mean age = 40.2; age range 18-87) with a physician-diagnosed food allergy [most commonly to gluten (54.6%), peanuts (21.3%), cow's milk (16.7%), and shellfish/seafood (16.7%)]. Participants completed an initial online survey that measured demographics, food allergy information, and personality traits using the Big Five Inventory (John et al., 1991). For 2 weeks, participants completed a daily online survey that queried the occurrence of 25 food allergy issues that day and participants' overall stress and mood that day. Neuroticism did not predict more frequent allergy issues or greater stress/poorer mood on days with more allergy issues. Instead, higher openness to experience predicted a range of issues including going hungry because there is no safe food available, problems finding suitable foods when grocery shopping, feeling anxious at social occasions involving food, being excluded, and feeling embarrassed and poorly understood about their food allergy. Conscientious people were less embarrassed or self-conscious about their food allergy, but they had more problems eating out, and their positive mood was more impaired by allergy issues than their less conscientious peers. Extraversion and agreeableness played minor roles. Personality testing can identify people that may have difficulty living with food allergies-such as those higher in openness to experience.

The stress of food allergy issues in daily life.

OBJECTIVE: Food allergies are a growing health concern, but their implications for daily psychological functioning are unknown. This micro-longitudinal study investigated the daily frequency of food allergy issues and how this related to experiences of stress, mood and physical energy. DESIGN: One hundred and eight adults with physician-diagnosed food allergies completed an initial Internet survey followed by a 2-week Internet daily diary survey. MAIN OUTCOME MEASURES: The initial survey collected socio-demographic and food allergy information. The daily survey collected information about the participants' experiences of stress, mood, physical energy and food allergy issues during that day. RESULTS: Commonly experienced allergy issues included negative physical symptoms, higher food prices, anxiety about safety of food, trouble maintaining a healthy diet and anxiety/stress at social occasions. Furthermore, multilevel modelling analyses showed that stress and negative mood were significantly higher on days with more allergy issues. Older adults experienced lower positive mood and physical energy on days with more issues. CONCLUSION: This is the first study to incorporate near to real-time tracking to examine the frequency of food allergy issues and the implications for daily psychological functioning. Targeting the issues we identified could reduce stress in patients with food allergies and improve their overall quality of life.

Understanding the Needs of Food-Allergic Adults.

Food allergies are a growing issue, yet society's understanding of how individuals' lives are affected is limited. We conducted four focus groups with food-allergic adults in New Zealand to gain an in-depth understanding of the issues that impacted their quality of life. Key themes identified included allergen-free eating issues, health care system issues, costs of having a food allergy, effects on well-being, external influences (e.g., others' lack of awareness), and internal influences (personal growth and adaptation). The unmet needs of food-allergic adults led to risk taking, increased stress, and social isolation. A lack of awareness in others (including medical professionals, food service providers, and the general public) had a negative impact, suggesting that an intervention targeting awareness would be beneficial. Adaptation, particularly in terms of assertiveness and organizational skills, was important for coping, so we suggest training in these skills be made available for food-allergic patients.