Exploring Dietitians' Perspectives Toward Current Practices and Services in Relation to Irritable Bowel Syndrome Management in Clinical Settings Across the United Kingdom: A Qualitative Study.

ABSTRACT

BACKGROUND: Irritable bowel syndrome (IBS) is a chronic and relapsing gastrointestinal condition that negatively impacts quality of life. Dietary triggers are common and dietary management is central to the IBS treatment pathway, and dietitians are the main education providers for patients. OBJECTIVE: The aim of this study was to explore dietitians' perspectives on current practices and services in relation to IBS management in clinical settings across the United Kingdom. DESIGN: Qualitative semi-structured interviews were undertaken from May to October 2021 via videoconferencing software. Eligible participants were dietitians specializing in gastroenterology and working in National Health Service (NHS) Trusts in the United Kingdom. Interviews were audio recorded and transcribed following intelligent transcription. Template analysis guided by naïve realism and its underlying epistemological assumptions was used. PARTICIPANTS/SETTING: Dietitians (N = 13) working in various NHS Trusts across the United Kingdom with at least 1 year of clinical experience in IBS management were included. QUALITATIVE DATA ANALYSIS: Template analysis, a form of thematic analysis with hierarchical coding, was used to explore dietitians' perspectives of IBS practices. RESULTS: Participating dietitians were mostly female (92.3%), of White race (84.6%), working in various NHS Trusts across the United Kingdom, and had more than 5 years of clinical experience (69.2%). The following 3 main themes emerged 1) dietetics services as part of IBS referral pathways; 2) practices in relation to dietetics services; and 3) patients' expectations and feelings. Each main theme had subthemes to facilitate the description and interpretation of data. The increasing number of IBS referrals to dietitians and the need for accurate and timely IBS diagnosis and specialist dietitians were reported, along with the use of digital innovation to facilitate practice and access to dietetic care. The use of internet as a source of (mis)information by patients and the limited time available for educating patients were identified as potential barriers to dietetic practice. Dietitians follow a patient-centered approach to dietary counseling and recognize the negative implications of perceived IBS-related stigma by patients on their feelings and treatment expectations. CONCLUSIONS: The study identified areas and practices that can facilitate access to dietetic services and patient-centered care in IBS management, as outlined in UK-based guidelines.