Developing meaningful client‐dietitian relationships in the chronic disease context: An exploration of dietitians' perspectives

Abstract

Aim Meaningful client‐dietitian relationships are central to effective dietetic practice. The chronic disease management setting provides an opportunity to examine what is meaningful and how these relationships are constructed, because the dietitian and client generally have multiple interactions over an extended period of time. This study aimed to explore dietitians' perspectives of how they develop meaningful relationships with clients managing lifestyle‐related chronic diseases. Methods Study design and analysis were guided by Charmaz's constructivist grounded theory. Dietitians working in Australia with clients managing chronic diseases were recruited through initial, snowball and theoretical sampling. Online videoconference and telephone semi‐structured interviews were conducted. Recorded interview transcripts were analysed using repeated reviews comprising initial, focused and theoretical coding and memoing. Results Twenty‐two dietitians were recruited. A conceptual model developed from the data showed the dietitian's role in developing the client‐dietitian relationship is complex. Key elements were identified and described as ‘Sensing a Professional Chemistry’, and the dietitian's skills in ‘Balancing Professional and Social Relationships’ and ‘Managing Tension with Competing Influences’. Influences were categorised as relating to the client and dietitian as individuals (eg, their values), their support network and external contextual factors (eg, working with interpreters). Conclusion Developing relationships with clients in the chronic disease context appears complex due to the dietitian's role of managing multiple interrelated elements and influential factors simultaneously. To deepen understanding, research should explore clients' perspectives of relationship development and how knowledge of practitioner‐client relationships in other disciplines may be utilised to enhance dietetic service delivery.

How is the client‐dietitian relationship embedded in the professional education of dietitians? An analysis of curriculum documentation and program coordinators' perspectives in Australia

“…Clear articulation of a competency framework was required to guide data extraction and analysis of curriculum documents 20 . To focus this specifically on the client‐dietitian relationship, a conceptual model previously published by our team was utilised 4 . This model provided a guide to more comprehensively identify activities related to the therapeutic relationship between a client and dietitian.…”

“…Elements of the model (as qualitative codes) were documented to form a coding framework for clear reference during data analysis (Table 1). 4 …”

“…Several papers described a need for skills development in university training, however since these articles were published, further research in this area and the impact on practice has not been forthcoming 1‐3 . More recent research from the United Kingdom has focused on training and assessing dietitians' communication skills, yet does not include other important skills shown to influence relationship development such as managing contextual influences (eg, physical environment) 4,5 . A recent study from Malaysia focused on the use of empathy amongst dietetic students, a component known to be important for relationship development, however again the study did not focus on other important skills 6 .…”

“…The findings from Ash et al indicate a shift towards dietitians training in a more patient‐centred style of healthcare 11 . They also underline a need to explore how dietitians are trained in all aspects of patient‐centred care, particularly therapeutic relationship development, which encompasses notions of trust, communication and empathy for beneficial change in health‐related outcomes 4,13 …”

Leadership and practice in times of complexity and uncertainty

“…A key component of leadership is taking initiative and developing solutions to problems 1 . Examples of this are illustrated in this issue of the journal from dietitian leaders supporting patients with cystic fibrosis and diabetes, 17 prescribing very low calorie diets for obese general elective surgery patients 18 and identifying what constitutes meaningful relationships with clients 19 . Embracing 'vulnerability' in leadership in solving problems is key to success.…”