Healthcare professionals’ experiences with practice for managing disease‐related malnutrition in general practice and proposals for improvement: A qualitative study

Abstract

Background & Aim Disease‐related malnutrition is prevalent in all healthcare settings, including general practice, and is associated with negative consequences for the individual and the community. The aim of this study was to investigate general practitioners and general practice nurses’ perceptions of how they manage disease‐related malnutrition, and their view on introducing an early intervention against disease‐related malnutrition. Methods Content analysis was used to analyse individual semi‐structured interviews with the general practitioners (n = 9) and five focus group interviews with the general practice nurses (n = 21) from five general practices in Denmark. Results General practice has no tradition for detection of disease‐related malnutrition and find that they rarely see patients with unintended weight loss. Nutritional guidance is to a low degree and only randomly performed. Furthermore, most of the health professionals do not have access to nutritional guidance material for patients and lack information about patients’ nutrition, when patients when patients receive treatment in the hospital. Suggestions for improvement were handouts with pictures and including nutritional status as a standard in the communication from hospital to general practice. An early intervention against unintended weight loss in specific groups was found feasible. Barriers and facilitators were seen as lack of time, lack of educational opportunities and skills. A financial incentive from the health authorities, and interventions adapted to the individual general practice were among suggested facilitators. Conclusion Disease‐related malnutrition was rarely recognised and managed in general practice. The health professionals found they lacked means to perform nutritional guidance to patients with unintended weight loss. However, the health professionals had suggestions for improvement for an early intervention including handouts for patients. Further research on implementation of early intervention against unintended weight loss in general practice is needed.

Perspective Chapter: Early Diagnosis of Malnutrition

“…Mikkelsen et al analyzed individual semi-structured interviews of general practitioners and focus group interviews of clinic nurses [21]. They reported that general practices did not routinely identify disease-related malnutrition and rarely saw patients with unintended weight loss.…”

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

“…Following demographic information, the semi-structured interview guide consisted of eight overall questions aimed at clarifying the roles and responsibilities regarding early detection and treatment of DRM, communication with patients about nutrition, opportunities and tools available for guidance, collaboration with other sectors and finally barriers and facilitators for implementation of nutritional intervention [28].…”

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

“…Based on the findings from study II, UWL is something the health professionals did not have focus on except if it is in front of the health professionals' eyes. This could be if a patient had a major and directly visible weight loss, thin patients or if the patients have other symptoms [83]. This is also found in a study from England, however the study also found that timely identification among patients at low risk need some improvements [99].…”

“…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).…”

“…In study II, the health professionals expressed that patients with UWL are rarely seen in general practice, and they did not use systematic detection of UWL as an indicator of malnutrition [83]. Other studies have found almost the same, as health professionals find it difficult to identify malnutrition at the first meeting with the patient and that malnutrition is second concern among GPs [63,64,99].…”