Do doctors know how much nutrition patients need—a survey from Germany?

Nutrition care is an integral part of patient-centred medical care: a European consensus

While healthcare is becoming more patient-centred, evidence-based nutrition interventions are still not accessible to all patients with cancer. As nutrition interventions directly improve clinical and socioeconomic outcomes, patient-centred care is not complete without nutrition care. While awareness of the negative impact of malnutrition on clinical outcomes, quality of life, and functional and emotional wellbeing in cancer is growing, there is relatively poor awareness amongst patients, clinicians, policymakers, and payers that nutrition interventions -particularly those begun in the early stages of the disease course- are an effective method for improving such outcomes. The European Beating Cancer Plan recognises the need for a holistic approach to cancer but lacks actionable recommendations to implement integrated nutrition cancer care at member state level. When considering nutrition care as a human right, the impact on quality of life and functional status must be prioritized, as these may be equally as important to patients, especially in advanced cancer where improvements in clinical outcomes such as survival or tumour burden may not be attainable. We formulate actions needed at the regional and the European level to ensure integrated nutrition care for all patients with cancer. The 4 main Take Home Messages are as follows: 1. The goals of Europe's Beating Cancer Plan cannot be achieved without integrating nutrition across the cancer care continuum. 2. Malnutrition negatively impacts clinical outcomes and has socioeconomic consequences for patients and healthcare systems. 3. Championing integrating nutrition care into cancer care is therefore the duty and ethical responsibility of clinicians (Hippocratic Oath-primum non nocere) and 4. Nutrition care is a cost effective, evidence-based therapy.

Clinical Nutrition in Portuguese Gastroenterology Departments: A Multicentric Study

BACKGROUND

Hospital nutrition is a major public health problem, as up to 50% of hospitalized patients suffer from undernutrition. Adequate nutritional support (NS) decreases morbidity/mortality, shortens the length of stay, and reduces costs. We aimed to evaluate the engagement of Portuguese gastroenterology departments in NS, especially in artificial nutrition (AN).

METHODS

Cross-sectional multicentric study, using an online survey sent to 31 Portuguese gastroenterology departments.

RESULTS

Nine centers were involved, and all departments were engaged in NS activities. The most performed nutrition technique was endoscopic gastrostomy and not all departments had the expertise to perform all nutrition procedures, namely, endoscopic jejunostomy. Two departments had an AN outpatient clinic. Five centers were involved in hospital nutrition committees. Only four performed systematic nutritional evaluation of every patient on admission. Two departments developed research in the nutrition field. An increase staff and nutrition training were pointed out as suggestions to improve NS.

CONCLUSIONS

This study outlines a broad picture of NS/AN in Portuguese gastroenterology departments. Medical nutritional training and increasing nutrition teams' staff may contribute to developing NS/AN. Multidisciplinary management of nutrition-related disorders is of utmost importance, and gastroenterologists are expected to be at the core of hospital nutrition.

Adherence to COVID-19 nutritional guidelines and their impact on the clinical outcomes of hospitalized COVID-19 patients

Background & aims

Coronavirus disease 2019 (COVID-19) patients are at high risk of malnutrition, and their doctors are part of a multidisciplinary team, including nutritionists. However, adherence to nutritional guidelines may be difficult in the context of capacity constraints during the COVID-19 pandemic. The aim of this study was to investigate barriers to doctors' adherence to nutritional guidelines and the impacts of guideline adherence on the outcomes of hospitalized COVID-19 patients.

Methods

A multinational electronic survey involving 51 doctors was conducted between November 2020 and January 2021 from 17 COVID-19-designated hospitals in countries with high (Indonesia) and low (Vietnam) numbers of confirmed COVID-19 cases.

Results

In general, doctors reported concerns related to nutritional practices in patients with Covid-19 which included feeling stress when performing medical nutritional therapy (65%), lacking self-efficacy or confidence in performing nutritional care (49%), lacking clear nutritional guidelines (45%), and experiencing budget limitations (33%). A regression analysis adjusted for age, country, and the number of hospitalized COVID-19 cases revealed that guideline knowledge (β: −1.01 (−1.78, −0.23); p = 0.012) and awareness of guidelines (β: −1.37 (−2.66, −0.09); p = 0.037) were negatively correlated with the length of stay of critically ill COVID-19 patients, but non-significant after adjusting for specialization of the doctor. When stratified according to country, a significant relationship between guideline adherence and length of stay of critically ill patients was only found in Vietnam [guideline adherence: β: −0.55 (−1.08, −0.03); p = 0.038; guideline knowledge: β: −1.01 (−1.9, −0.13); p = 0.027] after adjusting for age, specialty, and number of hospitalized COVID-19 cases. In Indonesia, the significant relationship between guideline adherence and mortality of COVID-19 patients remained strong (β: −14 (−27, −1); p = 0.033) after adjusting for age, specialty, and number of hospitalized COVID-19 cases

Conclusions

Inadequate nutritional knowledge is a key barrier to guideline adherence, and this was international and may be related to doctors' specialties and the COVID-19 pandemic. Adherence to nutritional guidelines may represent a prognostic factor for survival in COVID-19 patients.

Quality of life, symptoms and dietary habits in oncology outpatients with malnutrition: A cross-sectional study

Cancer-related malnutrition has a high prevalence, reduces survival and increases side effects. The aim of this study was to assess oncology outpatients and risk of malnutrition. Reported symptoms and quality of life (QoL) in patients found to be at risk of malnutrition or malnourished were compared to patients without malnutrition. Using a standardized questionnaire, the European Organization for Research and Treatment of Cancer Questionnaire for Quality of Life and the Mini Nutritional Assessment (MNA), patients in an outpatient cancer clinic undergoing chemotherapy treatment at a German University Hospital were assessed for nutrition, risk of malnutrition and quality of life. Based on the MNA, 39 (45.9%) patients were categorized as malnourished or at risk for malnutrition. Loss of appetite (n = 37.6%, p < 0.001) and altered taste sensation (n = 30,3%, p < 0.001) were the symptoms most frequently associated with reduced food intake. Patients with risk of malnutrition scored lower on the global health status (n = 48.15%, p = 0.001). Side effects of cancer treatments lead to a higher risk of malnutrition and as a consequence lower QoL. These side effects should be addressed more efficiently in cancer care.

Australian and New Zealand Medical Students' Attitudes and Confidence Towards Providing Nutrition Care in Practice

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students’ attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students’ (1) attitudes toward the role of nutrition in health, (2) nutrition knowledge based on nutrition-specific competencies and (3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: (1) role of medical practitioners in nutrition care, (2) barriers to nutrition education, (3) nutrition knowledge, and (4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority.

Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors

OBJECTIVES

Provision of nutritional support (NS) can improve disease outcome and shorten hospital length of stay. NS, often prescribed by medical doctors, requires adequate clinical nutrition (CN) expertise. The aim of this study was to investigate self-perceived and actual CN knowledge among medical doctors in Greece.

METHODS

Internal medicine physicians and surgical specialties (residents and specialized) were asked to self-evaluate their CN expertise, via a seven-item questionnaire and to complete a 20-question multiple-choice test on CN topics, with the aim of evaluating their actual CN knowledge. Participants were discouraged from accessing literature/information during the completion of either questionnaire.

RESULTS

Of 182 invited medical doctors, 115 (50.4% surgical specialties) participated in the study (63.2% response rate). The majority of participants (65.2%) demonstrated inadequate CN knowledge, with 30.4% of those scoring low having a high self-perception of their CN expertise. Comparison of perceived and actual CN knowledge revealed that only 56.5% of the participants estimated their knowledge correctly. Those who had participated in CN continuous medical education courses demonstrated increased related expertise (P = 0.002).

CONCLUSIONS

Medical doctors in Greece demonstrate low knowledge of fundamental CN principles, jeopardizing the provision of high-quality and efficient NS. Most importantly, the majority of participants overestimated their CN knowledge and prescribe artificial nutrition or participate in related decision making. Physicians' CN knowledge should be enhanced accordingly, either by attending CN modules during their studies, by participating in basic and advanced courses or CN-specific continuous medical education, or both.