Cancer Services, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
Nutrients. 2020 May 19;12(5):1465. doi: 10.3390/nu12051465.
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.
营养不良在头颈部癌症（HNC）患者中很普遍，影响治疗效果。尽管已经发布了营养护理循证指南（EBG），但仍然存在证据与实践之间的差距。本研究旨在将以患者为中心的最佳实践饮食护理模式整合到 HNC 多学科团队（MDT）中，以最大程度地减少营养不良的不良后果。采用混合方法的前后研究设计，结合基于证据的实施策略，针对个人、团队和系统层面上的障碍和促进因素，实施关键干预措施。在实施前瞻性队列研究之前，对病历进行数据审核，以确定 EBG 和临床参数的基线依从性。关键干预措施包括每周的支持性护理主导的治疗前诊所和营养护理仪表板，突出显示整合到 MDT 会议中的营养结果数据。焦点小组提供了团队层面的新护理模式的评估。经济分析确定了系统层面的影响。基线临床审计（n = 98）揭示了障碍，包括反应性营养护理、对 EBG 的不熟悉或对强化营养护理需求的认识、基础设施和饮食资源限制。实施后的数据（n = 34）显示出了改善的过程和临床结果：治疗前营养师评估；在治疗前、治疗中和治疗后使用经过验证的营养评估工具。接受新模式护理的患者更有可能完成规定的放疗和系统治疗。体重变化百分比的平均差异具有临床意义。在系统层面上，新模式的护理避免了 3.92 例非计划性入院和每年 121,000 澳元的相关费用。焦点小组在多学科团队层面上确认了对继续新模式护理的明确支持。在头颈部癌症患者中实施基于证据的营养护理模式是可行的，并且可以改善治疗效果。这种护理模式的好处可能适用于癌症环境中的其他患者群体。
