Communication about Disease-Related Malnutrition in the Perspective of Health Professionals in General Practice and Patients

Abstract

Aim:To investigate what elements are perceived necessary for early management of disease-related malnutrition in general practice and based on this knowledge, to provide recommendations for an effective communication strategy. Background: Disease-related malnutrition is associated with negative consequences for the individual and the community. Communication about early-stage malnutrition in general practice may prevent unnecessary deterioration, however nutritional guidance for cancer patients at an early stage and strategies to perform the optimal communication with the individual patient in general practice are lacking. Design: Mixed qualitative interview study. Methods: Seven patients suffering from cancer and early weight loss were interviewed and a second analysis was made of interviews with general practitioners and general practice nurses. An interpretive thematic analysis based on Health Belief Model, Self Determination Theory and Communication Theory was used. Results: Based on the analysis, patients were not guided towards maintaining weight in general practice. Health professionals in general practice were willing to give nutritional guidance, but need nutritional education, tools and communication strategies. Based on the analysis, recommendations for managing patients with an unintended weight loss were provided in relation to a communication strategy with following themes: 'Strategy and preparation of health professionals', 'Means of communication' and 'Forms of message'. Conclusion: This research provides insights into the demands for an improved early management of disease-related malnutrition in general practice, and furthermore recommendations for a communication strategy for providing and disseminating nutritional guidance and early patient guidance in general practice. Summary StatementWhat is already known about this topic?• Knowledge about disease-related malnutrition in general practice is sparse.• Health communication is important, as it facilitates behavior changes in health promotion and disease preventive interventions.• Barriers for managing disease-related malnutrition by general practice nurses and general practitioner are lack of time, skills and information about disease-related malnutrition. What this paper adds?• Nutritional education in general practice may increase competencies and the motivation to give nutritional guidance to patients with disease-related malnutrition.• Attention to patients' nutritional symptoms and a patient-involving practice seems important to enhance the patients' ability to act on health information regarding nutrition.• General practitioners and general practice nurses need to be aware of means of communication adapted to the individual, focusing on appeal, syntax, lexis and layout when giving the patients nutritional guidance.• The use of a communication strategy is an effective tool for describing objectives, messages, relevant media and timing within a specific intervention.• The suggested communication strategy may be relevant for similar nutritio...

Nutritional Risk in General Practice: Prevalence of Unintended Weight Loss; Facilitators, Barriers, and the Feasibility of an Early Patient-Involving Nutritional Intervention Among Patients With Suspected Malignant Disease

“…The financial perspective has been found as a barrier for handle patients with UWL as initial indicator of malnutrition in study II and III as well as in other studies [83,84,99,148]. This highlighting the need for organizational changes in primary care if general practice should be motivated to screen and treat citizens and patients with UWL and therefore being in nutritional risk.…”

“…In this section, the results and findings will be presented based on the three published papers I-III and the submitted manuscript IV. Further results and findings are described in detailed in the papers I-III (Appendix 6-8 and [82][83][84]) and manuscript IV (Appendix 9).…”

“…This is also recommended in the ESPEN guidelines and from the Danish Health Authority [1]. Furthermore, the health professionals also expressed that some patients enjoy an easy weight loss [83,84], however the patients in study III express that they did not like losing the control related to the weight loss [84]. Other studies have found that patients can have some attitudes to nutrition and can have been misled by health eating messages from the environment [99,148,149].…”

“…In study II and III, the health professionals highlighted the need for more education and they need to improve their skills in providing nutritional guidance [83,84]. Other studies have found that health professionals in general practice need training and knowledge about nutrition and screening tools [63,64,99,[147][148][149][150][151].…”

“…In study II and III, the health professionals expressed the need to consider the patients' socioeconomic status and provide individualized nutritional guidance and interventions [83,84]. This is also recommended in the ESPEN guidelines and from the Danish Health Authority [1].…”