Healthcare professionals' perspectives on the role of dietitians within multidisciplinary head and neck cancer teams: A qualitative multi‐site study

Abstract

Aim: Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes.Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals.Methods: This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. Results: Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines."Conclusions: While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.

Exploring stakeholder experiences of dietetic service and care delivery: A systematic qualitative review

“…26,[28][29][30]36,37,39,40,42,[44][45][46][47][48][49][50][52][53][54][55]59,62,[65][66][67][68][69] Four studies investigated dietitians experiences of delivering nutrition care, 32,51,56,60 and four studies explored the experiences of both patients and dietitians. 34,41,63,66 Nine studies explored the experiences of healthcare staff groups who interacted with dietitians and nutrition care team, including multidisciplinary healthcare teams, 31,35,43,57,58 general practice health professionals, 27,61 obstetricians and gynaecologists, 64 general hospital staff and staff at an industrial steel works. 38 Settings from included studies were acute hospitals (n = 23), 26,28,31,…”

“…34,41,63,66 Nine studies explored the experiences of healthcare staff groups who interacted with dietitians and nutrition care team, including multidisciplinary healthcare teams, 31,35,43,57,58 general practice health professionals, 27,61 obstetricians and gynaecologists, 64 general hospital staff and staff at an industrial steel works. 38 Settings from included studies were acute hospitals (n = 23), 26,28,31,35,36,39,42,43,[45][46][47]49,50,[52][53][54][55]57,58,64,[66][67][68][69] primary care services (n = 7), 27,29,31,32,48,62,63 community health centres (n = 4), 30,37,52,56 ambulatory and outpatient ...…”

“…40 Five studies included multiple settings, including hospitals, community health centres and private practices. 34,[59][60][61]65 Nutrition care was related to the following health issues and medical conditions: cancer, 28,36,43,[45][46][47]49,53,65 type 2 diabetes, 11,30,60,61 overweight and obesity, 26,27,33,44,48,67,69 prenatal care, 64 mental health, 40,49 renal disease, 50,51,54,55,66 coeliac disease, 52 post traumatic brain injury 35 and lifestyle and chronic diseases. 29,31,32,38,39,41,56 The studies that included obesity also involved patients in the context of bariatric surgery 26 and women with obesity in antenatal care 44 and postnatal care.…”

“…60 Both patients and dietitians identified that the value placed on dietetic care by referring practitioners played an influential role in choosing to access dietetic services, with doctors' referrals being particularly motivating. 43,51 Encouraging or ambivalent attitudes towards dietitians influenced the patient's decision to access dietetic service affecting the patient's decision to attend, continue or terminate dietetic counselling. 39,44 Patients who had access to dietetic care sometimes perceived that this care mismatched their disease trajectory.…”

The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis

“…Likewise, the dietitian in this study provided anticipatory guidance, problem solving for symptom management and guidance when contact with another health professional was indicated. Both health professionals and patients recognise the value of the oncology dietitian's ability to prepare patients for common challenges that occur throughout the cancer journey [16,28,32,33]. Evidence suggests that patient navigation services bene t patients through addressing worries and reducing incidence of hospital admissions and emergency department attendance [34][35][36].…”