Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes

Findlay, M; Rankin, NM; Shaw, T; White, K; Boyer, M; Milross, C; De Abreu Lourenco, R; Brown, C; Collett, G; Beale, P; Bauer, JD

Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes

Findlay, M Rankin, NM Shaw, T White, K Boyer, M Milross, C De Abreu Lourenco, R

Brown, C Collett, G Beale, P Bauer, JD

Permalink

Publisher:: MDPI AG
Publication Type:: Journal Article
Citation:: Nutrients, 2020, 12, (5), pp. 1465-1465
Issue Date:: 2020

Open Access

Copyright Clearance Process

Recently Added
In Progress
Open Access

This item is open access.

Adobe PDF

Download Accepted versionAdobe PDF (263.22 kB)

View on publisher's site

View statistics

Full metadata record

Field	Value	Language
dc.contributor.author	Findlay, M
dc.contributor.author	Rankin, NM
dc.contributor.author	Shaw, T
dc.contributor.author	White, K
dc.contributor.author	Boyer, M
dc.contributor.author	Milross, C
dc.contributor.author	De Abreu Lourenco, R https://orcid.org/0000-0002-5978-8774
dc.contributor.author	Brown, C
dc.contributor.author	Collett, G
dc.contributor.author	Beale, P
dc.contributor.author	Bauer, JD
dc.date.accessioned	2020-10-01T19:42:52Z
dc.date.available	2020-05-14
dc.date.available	2020-10-01T19:42:52Z
dc.date.issued	2020
dc.identifier.citation	Nutrients, 2020, 12, (5), pp. 1465-1465
dc.identifier.issn	2072-6643
dc.identifier.issn	2072-6643
dc.identifier.uri	http://hdl.handle.net/10453/142969
dc.description.abstract	<jats:p>Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.</jats:p>
dc.format	Electronic
dc.language	en
dc.publisher	MDPI AG
dc.relation.ispartof	Nutrients
dc.relation.isbasedon	10.3390/nu12051465
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	0908 Food Sciences, 1111 Nutrition and Dietetics
dc.title	Best Evidence to Best Practice: Implementing an Innovative Model of Nutrition Care for Patients with Head and Neck Cancer Improves Outcomes
dc.type	Journal Article
utslib.citation.volume	12
utslib.location.activity	Switzerland
utslib.for	0908 Food Sciences
utslib.for	1111 Nutrition and Dietetics
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Strength - CHT - Health Technologies
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	open_access	*
pubs.consider-herdc	true
dc.date.updated	2020-10-01T19:42:39Z
pubs.issue	5
pubs.publication-status	Published online
pubs.volume	12
utslib.citation.issue	5

Abstract:

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting outcomes. Despite publication of nutrition care evidence-based guidelines (EBGs), evidence–practice gaps exist. This study aimed to implement and evaluate the integration of a patient-centred, best-practice dietetic model of care into an HNC multidisciplinary team (MDT) to minimise the detrimental sequelae of malnutrition. A mixed-methods, pre–post study design was used to deliver key interventions underpinned by evidence-based implementation strategies to address identified barriers and facilitators to change at individual, team and system levels. A data audit of medical records established baseline adherence to EBGs and clinical parameters prior to implementation in a prospective cohort. Key interventions included a weekly Supportive Care-Led Pre-Treatment Clinic and a Nutrition Care Dashboard highlighting nutrition outcome data integrated into MDT meetings. Focus groups provided team-level evaluation of the new model of care. Economic analysis determined system-level impact. The baseline clinical audit (n = 98) revealed barriers including reactive nutrition care, lack of familiarity with EBGs or awareness of intensive nutrition care needs as well as infrastructure and dietetic resource limitations. Post-implementation data (n = 34) demonstrated improved process and clinical outcomes: pre-treatment dietitian assessment; use of a validated nutrition assessment tool before, during and after treatment. Patients receiving the new model of care were significantly more likely to complete prescribed radiotherapy and systemic therapy. Differences in mean percentage weight change were clinically relevant. At the system level, the new model of care avoided 3.92 unplanned admissions and related costs of $AUD121K per annum. Focus groups confirmed clear support at the multidisciplinary team level for continuing the new model of care. Implementing an evidence-based nutrition model of care in patients with HNC is feasible and can improve outcomes. Benefits of this model of care may be transferrable to other patient groups within cancer settings.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/142969