Nutrition-related hospital presentations and admissions among radiotherapy outpatients: a systematic literature review.

BACKGROUND: Unplanned presentations and admissions to hospital among outpatients with cancer are a key indicator of quality care in cancer services. Nutritional issues including malnutrition and dehydration, which fall under the dietitian's scope of practice, can result in unplanned contacts. The present review focused on cancer outpatients undergoing radiotherapy as a particular at risk group and aimed to provide a comprehensive overview of the range and prevalence of nutrition-related unplanned contacts and the associated factors, including the role of dietetic intervention. METHODS: A systematic review analysed studies published between 1990 and August 2016 from five databases. Eligible studies reported rates of nutrition-related unplanned contacts among adult nonhaematological cancer outpatients, treated with nonpalliative radiotherapy. Studies were screened for eligibility, extracted, descriptively analysed and synthesised. RESULTS: Fifteen studies were included. Common causes of nutrition-related unplanned contacts included dehydration and enteral feeding commencement and complications. Factors that influenced nutrition-related unplanned contacts included tumour location and stage, treatment modality and the presence of a feeding tube. There were issues in determining the prevalence and identifying dietetic interventions partly as a result of the heterogeneity in reported study designs and varying definitions of nutrition-related unplanned contacts. CONCLUSIONS: Nutrition-related problems appear to be associated with unplanned contacts in cancer outpatients undergoing radiotherapy. Hence, there is a strategic need for dietetic involvement aiming to reduce these. Further research is required to define the role of the dietitian in managing nutrition-related unplanned contacts, particularly for dehydration. This may help to define the full scope of practice for dietitians caring for these nutritionally vulnerable and complex outpatients.

Building bridges in dietary counselling: an exploratory study examining the usefulness of wellness and wellbeing concepts.

BACKGROUND: Over the last decade, professional discourse around health ownership has been evolving to recognise an individually-driven wellness/wellbeing approach. Concurrently, dietetic competencies have changed to include client-centred counselling incorporating individual client's perspectives within dietary prescriptions. The present exploratory research aimed to explore how client-centred counselling practice was being represented in the dietetic literature and to examine dietitians' perspectives about working with clients in the current environment. METHODS: To explore the professional position, a literature search was conducted using keywords encompassing client-centred care and competency within professional dietetic journals (2001-2010). To develop a contextual case study, 10 in-depth interviews with dietitians delivering weight-loss prescriptions within a clinical trial were conducted. Recordings of their perspectives on roles, opportunities/barriers and counselling strategies were transcribed verbatim and examined using inductive thematic and content analysis. RESULTS: Eleven articles were incorporated into a narrative review describing practice issues related to traditional forms of consultation and the effectiveness of client-centred approaches. The over-riding theme from the interviews (Professional Identity Dilemma) highlighted tension felt by dietitians in their dual role as nutrition expert and counsellor, trained to deliver biomedical imperatives (clinical targets), and their challenge to accept client-defined health perspectives. Supporting themes (Adherence factors and Constructs of health) exposed details on barriers to dietary change and the impact of contextual factors on this change that were linked to wellness and wellbeing concepts. CONCLUSIONS: Appreciating wellness and wellbeing concepts may add a useful adjunct to client-centred approaches to dietary counselling through building bridges between clinical targets and client health perspectives.

What do the terms wellness and wellbeing mean in dietary practice: an exploratory qualitative study examining women's perceptions.

BACKGROUND: Wellness and wellbeing are terms associated with health within dietetic discourse. More broadly, these terms are found in social discourse as represented in food and nutrition consumer communications. With the increasing requirement for evidence-based healthcare, there is an imperative to understand whether these terms are meaningful to individuals typically targeted for nutrition interventions and whether there are any implications for dietetic education. METHODS: To explore the understanding of these terms, eight semi-structured focus groups were conducted with 32 female participants (age range 23-79 years) who were actively engaged in managing their health. Overall understanding of the terms, factors that impacted perceptions and any relationships with food behaviour were investigated with the groups. Group discussions were transcribed verbatim and each transcript was examined by two researchers. Inductive analysis linking codes into main thematic categories was conducted using the constant comparison approach across the full data set. RESULTS: Wellness and wellbeing were identified as meaningful terms associated with health. A theoretical framework of wellness and wellbeing reflecting these meanings was developed linking four dominant thematic areas. These were Desired outcomes (most sought after result); Taking control (self management strategies); Internal influences (various personal inner factors influencing behaviours); and External influences (plethora of peripheral factors influencing behaviours). CONCLUSIONS: Wellness and wellbeing are terms that are relevant and aspirational for individuals typically targeted for nutrition intervention. A theoretical framework of dominant areas of influence on notions of wellness and wellbeing was identified. This theoretical framework is worthy of further research to determine usefulness and effectiveness in dietetic practice settings.

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients.

OBJECTIVES: Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia. PARTICIPANTS: A convenience sample of 12 MOW clients. INTERVENTION: Participants received snacks five times a week, in addition to their usual MOW order, for four weeks. MEASUREMENTS: Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients' homes were digitally recorded, transcribed verbatim, and themes identified. RESULTS: Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477) /day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as 'malnourished' or 'at risk of malnutrition' decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status. CONCLUSION: Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.