Patients report positive nutrition counseling outcomes

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

BACKGROUND

There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.

METHODS

MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.

RESULTS

Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.

CONCLUSIONS

Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.

The impact of a nutrition counseling program on the use of hospital services for Meals on Wheels clients

Home-delivered meals have shown considerable promise in overcoming nutritional challenges among homebound older adults facing food insecurity and the risk of diabetes, while nutrition counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a program combining nutrition counseling with home-delivered meals by examining the use of hospital services 6 months before and after participating in the program. This study included 1009 clients who are at risk for diabetes and who received home-delivered meals and nutrition counseling via Meals on Wheels in Fort Worth, Texas. Hospital service data were extracted from a regional claims database. Generalized linear models were performed to examine changes in use of hospital services 6 months before and after program participation. The mean number of emergency department visits and hospitalizations decreased from 0.69 to 0.50 (p < .001) and from 0.35 to 0.22 (p < .001), respectively. The findings of this study indicate that combining structured nutritional counseling with home-delivered meals may contribute to reducing healthcare use among older adults facing the challenges of diabetes and food insecurity.

An Innovative Approach to Designing Digital Health Solutions Addressing the Unmet Needs of Obese Patients in Europe

According to the World Health Organization (WHO), the worldwide obesity rate has tripled since 1975. In Europe, more than half of the population is overweight and obese. Around 2.8 million people die each year worldwide as a result of conditions linked to being overweight or obese. This study aimed to analyze the policies, approaches, and solutions that address the social and health unmet needs of obese patients, at different levels, in order to simulate the definition of an integrated approach, and to provide and share examples of innovative solutions supporting health promotion, disease prevention, and integration of services to improve the collaboration between the different health and care stakeholders involved across the country and in the lives of obese patients. A collaborative approach involving various levels of government and regional experts from different European countries was applied to identify, explore, and evaluate different aspects of the topic, from the innovation perspective and focusing on a European and a regional vision. Currently, people prefer more foods rich in fats, sugars, and salt/sodium than fruits, vegetables, and fiber. This behavior leads to a significant negative impact on their health-related quality of life. Changes in healthcare systems, healthy policy, and approaches to patient care and better implementation of the different prevention strategies between all the stakeholders are needed, taking advantage of the digital transformation of health and care. Such changes can support obese patients in their fight against an unhealthy lifestyle and at the same time reduce healthcare costs.

Necessary Knowledge and Skills for Dietitians in Saudi Arabia: A Qualitative Study

BACKGROUND

Dietitians play a major role in health promotion and chronic diseases prevention. Graduates from clinical nutrition and dietetics major should be equipped with the necessary knowledge and skills for their role to be more effective. The purpose of this study is to investigate the knowledge and skills needed by current and future graduates in clinical nutrition and dietetics.

METHODS

In this qualitative study, structured interviews by focus groups were conducted. Dietitians from different governmental and private sectors were invited to participate in the study. Focus groups were stratified based on the participants' gender and years of experience to promote self-disclosure. Abridged transcript of relevant and useful points was performed. The transcripts were coded and cross-validated by two researchers.

RESULTS

A total of four focus groups were conducted. Two focus groups comprise 9 male participants and the other two comprise 10 females. The age of participants ranged 25-40 years old. Participants were employees in Riyadh city with experience that ranged 3-10 years old. Nine themes of the necessary knowledge and skills were identified.

CONCLUSION

It is recommended for the Saudi government to create standards specialised for clinical nutrition and dietetics undergraduate and graduate programmes.

Assessment of dietitians' nutrition counselling self-efficacy and its positive relationship with reported skill usage

BACKGROUND

Previous studies on nutrition counselling self-efficacy have assessed small groups of dietitians in focused practice areas or evaluated the effectiveness of skills training on only a few skills. This descriptive study developed a comprehensive scale to examine self-efficacy in a large, cross-sectional sample of practising dietitians when performing various counselling skills that promote dietary behaviour changes.

METHODS

A valid and reliable instrument was developed and administered through the Internet to survey dietitians in the USA from various areas of dietetics and with varying years of experience. Items included counselling self-efficacy, skill usage and counselling-related job characteristics. Of the 612 respondents, one group (n = 486) conducted counselling for more than 50% of their work week, and the other group (n = 126) for less than 50%. Factor analysis was used for scale development. Independent samples t-tests and chi-square tests were performed for group comparisons. Correlations and multiple regression analyses further assessed the relationships among variables.

RESULTS

The resultant unidimensional scale contained 25 items. Dietitians reported high self-efficacy scores and frequent skill usage. Those who counsel for more than 50% of their work week were more likely to work in outpatient settings and private practice, reported higher self-efficacy scores, and held longer and repeated sessions. Self-efficacy scores were positively correlated with counselling-related job characteristics. Years of counselling experience and skill usage significantly predicted self-efficacy scores.

CONCLUSIONS

Dietitians perceive themselves to be highly self-efficacious in using counselling skills which may contribute positively to their professional practice. However, the relationship between counselling self-efficacy and actual performance warrants further investigation.

Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

BACKGROUND

According to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians' expertise in the hospital units and, further, to assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition.

METHODS

A questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common, as well as to 678 clinical dietitians working in Scandinavian hospitals.

RESULTS

The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians.

CONCLUSIONS

The present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus on clinical nutrition.

A measure of satisfaction with food-related life

A measure of satisfaction with food-related life is developed and tested in three studies in eight European countries. Five items are retained from an original pool of seven; these items exhibit good reliability as measured by Cronbach's alpha, good temporal stability, convergent validity with two related measures, and construct validity as indicated by relationships with other indicators of quality of life, including the Satisfaction With Life and the SF-8 scales. It is concluded that this scale will be useful in studies trying to identify factors contributing to satisfaction with food-related life.

Effect of nutrition counselling on client perceptions and eating behaviour

PURPOSE

Demonstrating the effectiveness of nutrition counselling is imperative, not only to promote successful patient outcomes but also to secure funding. This study therefore assessed the value and effectiveness of nutrition counselling.

METHODS

To measure clients' perceptions of the value of inpatient counselling, the Clients' Perceptions about Nutrition Counselling (CPNC) instrument was administered to 164 clients one week after hospital discharge. To determine if inpatient nutrition counselling is effective in promoting changes in eating behaviours, the same clients were asked to complete the Health Habits and History Questionnaire (HHHQ) before counselling and then at three and six months following discharge.

RESULTS

The majority of respondents who completed the CPNC indicated that the information provided by the dietitian was useful, that the dietitian was knowledgeable, and that they knew what to eat after speaking with the dietitian and had changed their diet according to the recommendations. From the HHHQ, respondents counselled for heart health diet modifications (n = 45) significantly lowered their intake of energy (p<0.002), fat, saturated fat, sodium, and cholesterol (all p<0.001) over time.

CONCLUSIONS

These results suggest that inpatient nutrition counselling is perceived as valuable and results in positive dietary behaviours, the majority of which are sustained at six months.

Patient-centred outcomes in dietary research

INTRODUCTION

Current health policy stresses the need to take patients' views into account in the provision of health care, including involvement in the process of care and determining the outcome(s) of treatment. It is unclear whether patients undergoing dietary treatment have been consulted on their views.

METHODS

A literature review, searching electronic databases and hand searching dietetic journals, of dietary intervention research was carried out to identify if patients' views were sought in determining outcomes.

RESULTS

Searching uncovered a total of 28 papers reporting the results of studies of dietary interventions where patients views were sought in the measurement of outcome, however little detail was given about patient(s) involvement and whether the use of the measures influenced future care.

FUTURE WORK

Should address the issue of patient involvement in the determination of outcome and how this then influences future care.

Resgate do conceito de aconselhamento no contexto do atendimento nutricional

O aconselhamento é um processo genérico de ajuda, cuja estrutura básica independe da área de conhecimento, o qual pode sustentar o atendimento nutricional a grupos e/ou indivíduos, quando então recebe a denominação de aconselhamento dietético. O objetivo do presente trabalho é resgatar o conceito e os fundamentos do aconselhamento, como referência teórica para a atividade de atendimento nutricional que envolve educação e orientação nutricional. A revisão dos fundamentos teóricos que permitiram a construção do modelo básico de aconselhamento, revela a influência e a contribuição relativa de várias correntes da psicologia, além da possibilidade de incorporação do pensamento de educadores identificados com as questões sociais e éticas da educação em saúde. As fases que compõem o processo de aconselhamento incluem: descoberta inicial, exploração em profundidade e preparação para ação. Ao longo do tempo, o foco do trabalho de aconselhamento foi deslocado dos conteúdos técnicos específicos, para a interação de ajuda. Tal deslocamento exigiu o desenvolvimento de competências e habilidades do aconselhador, para compreender e ajudar as pessoas a efetivarem as mudanças necessárias na vida cotidiana e nos construtos pessoais. Por meio desse panorama teórico, conclui-se que o aconselhamento dietético pode prover ao nutricionista um instrumental teórico que lhe permite aprimorar suas habilidades e competências, com o fim de intervir sobre o comportamento alimentar do cliente, respeitando sua autonomia e valorizando seu potencial como sujeito histórico.

Development of a medical nutrition therapy protocol for female collegiate athletes

Nutrition intervention can improve athletic performance and reduce the risk of nutrition related problems in women athletes. The current healthcare environment demands that dietitians document the outcomes of the medical nutrition therapy (MNT) they provide. This requires the development and validation of MNT protocols so that outcomes can be documented and compared in similar populations across multiple settings. The purpose of this project was to develop a sports nutrition management MNT protocol for collegiate women athletes. A registered dietitian currently working with collegiate women athletes collaborated with four dietitians from the community to develop an MNT protocol. Further testing and validation using this MNT protocol will help dietitians document the outcomes of their interventions in this population.

Dietitian intervention improves lipid values and saves medication costs in men with combined hyperlipidemia and a history of niacin noncompliance

We asked if medical nutrition therapy (MNT) administered by registered dietitians could lead to beneficial clinical and financial outcomes in men with combined hyperlipidemia (hypercholesterolemia and hypertriglyceridemia). A retrospective chart review was conducted on 73 men with combined hyperlipidemia who were being considered for statin therapy because of a previous history of noncompliance with niacin therapy. Subjects participated in an 8-week dietitian intervention program as a qualifying requirement, before statin therapy. Patient records were reviewed to determine the beginning and ending serum lipid concentrations and the number and length of dietitian sessions. Complete information was available on 43 subjects, aged 60.7 +/- 10.1 years (mean +/- standard deviation). Total dietitian intervention time was 169 +/- 19 minutes in 2.7 +/- 0.6 sessions (range = 2 to 4 sessions) during 6.5 +/- 2.2 weeks of MNT (range = 4 to 8 weeks). MNT lowered levels of total cholesterol 11% (P < .001), low-density lipoprotein cholesterol 9% (P < .001), and triglycerides 22% (P < .0001) and body mass index 2% (P < .0001); MNT raised high-density lipoprotein cholesterol levels 4%. After dietitian intervention, only 15 of 30 eligible patients required antihyperlipidemic medications, which led to an annual cost savings of $27,449.10 or $638.35 per patient. A cost saving of $3.03 in statin therapy was realized for each dollar spent on MNT. We conclude that an average of 3 individualized dietitian visits of 1 hour each over an 8-week period has a beneficial effect in treating patients with combined hyperlipidemia and recommend consideration of MNT as a cost-effective intervention.

The syndrome of anorexia-cachexia

Cancer anorexia/cachexia is a major clinical problem, especially in advanced cancer patients. Its pathogenesis is quite complex. Anorexia plays a central role, but cancer cachexia is more complex than pure chronic starvation. One of the key differences is the preferential mobilization of fat and the sparing of skeletal muscle in simple starvation compared with an equal mobilization of fat and skeletal muscle in cancer patients. An increase in basal energy expenditures seems to play a contributory role in many patients. Cytokines, essentially but not exclusively tumor necrosis factor alpha, play an essential role, and the syndrome can be compared with a low-grade chronic inflammatory state. As it is in most fields in medicine, prevention is more efficacious than treatment, and, to avoid the final and dramatic stages of cancer cachexia, adequate nutritional advice and support must be provided sufficiently early. Parenteral nutrition could facilitate the administration of complete doses of chemotherapy or radiotherapy, but no significant survival benefit or decrease in treatment-induced toxicity have ever been demonstrated in prospective randomized trials. The gut should always be used if at all possible. Percutaneous endoscopic gastrostomy is used increasingly in patients who cannot eat but who have functionally intact gastrointestinal tracts, especially in patients with head and neck cancer. Eight randomized, double-blind, placebo-controlled studies have demonstrated that progestational drugs can somewhat stimulate appetite, food intake, and energy level; increase weight in many patients; and often decrease nausea and vomiting severity; however, pharmacologic treatment of cancer cachexia remains disappointing, and more trials with anticytokine drugs should be conducted.