Department of Dietetics and Nutrition, Nottingham University Hospitals NHS Trust, Nottingham, UK.
School of Medicine and Population Health, University of Sheffield, Sheffield, UK.
J Hum Nutr Diet. 2024 Aug;37(4):1007-1021. doi: 10.1111/jhn.13315. Epub 2024 May 2.
Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre-HCT in UK centres.
An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time.
Seventy-seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre-HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty-two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non-dietitians most routinely provided dietary advice pre-HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high-energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre-HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre-HCT.
Nutrition and prehabilitation pre-HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.
营养预康复可能改善造血细胞移植（HCT）的结果，尽管证据有限。本研究旨在了解英国中心的医疗保健专业人员（HCP）对预康复和 HCT 前营养护理的看法。
通过电子邮件向 39 家英国成人中心的多学科 HCP 发放了一份匿名在线调查（通过内容专家和试点进行了开发和完善）。数据以反应的比例表示。常规供应表示护理提供的时间超过 70%。
77%（n=66）的 HCP 做出了回应，代表了 61.5%（n=24）的英国成人 HCT 中心。所有 HCP 都支持预康复，提出在诱导化疗期间（60.4%；n=40）和首次 HCT 诊所（83.3%；n=55）之间进行可行的实施。只有 12.5%（n=3）的中心设有专门的预康复服务。营养（87.9%；n=58）、情绪健康（92.4%；n=61）和运动（81.8%；n=54）被认为是非常重要的组成部分。HCT 中心一半以下的 HCP（n=12 个中心）报告常规使用 HCT 前的营养筛查工具进行营养筛查，其中 12 个中心使用的是经过验证的工具；66.7%的 HCP（n=36）报告使用营养不良通用筛查工具（MUST）。62%（n=41）的 HCP 报告有风险的患者接受了营养评估，主要由营养师（91.6%；n=22）使用饮食护理过程（58.3%；n=14）进行评估。HCP 最常报告的身体成分测量是体重指数（BMI）（70.2%，n=33）。在 59 名回答者中，非营养师在 HCT 前最常提供饮食建议（82.4%；n=28 与 68%；n=17，p=0.2）；包括高能/高蛋白/高脂肪和中性粒细胞减少症饮食建议。HCT 前预防性肠内喂养很少见，这表明 BMI 低和体重意外显著下降。近一半（n=25 名，42.4%）的 HCP 报告在 HCT 前定期提供运动建议。
HCP 认为 HCT 前的营养和预康复很重要且可实现，但英国中心目前的供应有限且不一致。
