Background Non-adherence with medications in pregnancy is increasingly recognized and often results in a higher rate of preventable maternal and fetal morbidity and mortality. Non-adherence with prophylactic aspirin amongst high-risk pregnant women is associated with higher incidence of preeclampsia, preterm delivery and intrauterine growth restriction. Yet, the factors that influences adherence with aspirin in pregnancy, from the women's perspective, remains poorly understood. Objective The study is aimed at understanding the factors, from the women's perspective, that influenced adherence with prophylactic aspirin in their pregnancy. Study design A sequential-exploratory designed mixed methods quantitative (n = 122) and qualitative (n = 6) survey of women with recent high-risk pregnancy necessitating antenatal prophylactic aspirin was utilized. Women recruited underwent their antenatal care in one of three highrisk pregnancy clinics within the South Western Sydney Local Health District, Australia. The quantitative study was done through an electronic anonymous survey and the qualitative study was conducted through a face-to-face interview. Data obtained was analysed against women's adherence with aspirin utilizing phi correlation (φ) with significance set at <0.05.

To our knowledge, this is the first dietitian-specific workplace education program of its type to address essential skills for better communication with patients. Ongoing workplace support, such as peer observation, is recommended to assist with skill development and sustainability.

Renal Supportive Care is an alternative treatment pathway in advanced chronic kidney disease that is being increasingly adopted, particularly in the elderly. Renal Supportive Care uses principles of palliative care and has been developed to enhance the care for dialysis patients with a high symptom burden and those being managed on a non‐dialysis pathway. Nutrition management is often an under‐recognized component of care and can play an important role in improving patients' quality of life to reduce symptom burden, support physical function and independence and provide appropriate counselling to patients and their families to ensure the goals of Renal Supportive Care are met. Nutrition interventions need to target patient and treatment goals, with frequent monitoring to ensure patient needs are being met. This review outlines available literature on this topic and suggests some practical ways in which nutrition can be enhanced for these patients.

SUMMARY Background Dietary changes recommended for chronic kidney disease (CKD) stages 4–5 and concurrent diabetes are difficult to follow given the multitude of food and fluid restrictions aimed at reducing the rate of CKD progression. Reduced adherence is commonplace and there is limited literature on patients’ experiences with dietary changes and potential strategies to overcome this. Objectives Examine patients’ experiences when adopting dietary changes recommended for CKD Stages 4–5 (pre‐dialysis) and diabetes, and their perceptions of dietetic services and how they can be improved to assist them with dietary change. Methods An exploratory qualitative study was undertaken using a purposive sampling method from a dietetic pre‐dialysis clinic. Participants were interviewed using a semi‐structured interview style. Data were analysed using an inductive thematic analysis from a constructivist perspective. Results Three themes were identified: (1) Negative motivation to change eating behaviour to avoid dialysis; (2) sustaining motivation for change is challenging due to a sense of loss and confusion to incorporate the dietary changes recommended and (3) support is needed for eating behaviour change. Conclusion These findings have implications for dietitians to enhance their understanding of the patient experience and improve their skills in motivational counselling. Development of dietitian‐specific communication and nutrition counselling programmes are recommended to equip dietitians with skills to better support patients. CKD Stage 3 nutrition education programmes could be beneficial to promote earlier access to dietetic services and dietary recommendations.

Aim A multidisciplinary approach, including dietetics, is considered the optimal model of care for dialysis preparation. Dietetic consultation (DC) focuses on symptom management and dietary changes to delay time to dialysis. Evidence of the effectiveness of DC on time to dialysis is limited. This study aimed to investigate the impact of DC on time to dialysis for patients attending a pre‐dialysis clinic. Methods A retrospective cohort study was designed to include all patients attending outpatient pre‐dialysis clinics at a large metropolitan renal service between January 2014 and March 2018. Time to dialysis (days) was compared between patients that received DC and those who did not. Cox proportional hazards analysis allowing for adjustment of differences and confounders was undertaken. Results A cohort of 246 patients was identified. Median estimated glomerular filtration rate was 16mL/min per 1.73 m2 (interquartile range = 13–20) at initial pre‐dialysis clinic visit and 63% commenced dialysis during the study period. Only 41% of patients received dietetic consultation. Significantly fewer patients needed to commence dialysis in the DC group compared to the no‐DC group (hazards ratio 0.63; 95% confidence interval (CI) 0.45–0.89; P = 0.008 Cox proportion hazard). The DC group commenced dialysis significantly later than the no‐DC group; 933 days (95% CI 832–1034) versus 710 days (95% CI 630–790) respectively, after the initial pre‐dialysis clinic visit; log–rank 0.005. Conclusion DC provided to patients attending a pre‐dialysis clinic was associated with a delayed time to dialysis. Standardised referral pathways to improve patient access to renal dietetic services are recommended to optimise care.