Purpose People living with and beyond cancer often experience nutrition-related issues and should receive appropriate advice on nutrition that is consistent and evidence based. The aim of this study was to investigate current practice for the provision of nutritional care by healthcare professionals (HCPs) from a UK national survey produced by the National Institute for Health Research (NIHR) Cancer and Nutrition Collaboration. Methods An online survey sent to professional groups and networks included questions on discussing nutrition, providing information, awareness of guidelines, confidence in providing nutritional advice, training and strategies for improving nutritional management. Results There were 610 HCPs who responded including nurses (31%), dietitians (25%), doctors (31%) and speech and language therapists (9%). The majority of HCPs discusses nutrition (94%) and provides information on nutrition (77%). However, only 39% of HCPs reported being aware of nutritional guidelines, and just 20% were completely confident in providing nutritional advice. Awareness of guidelines varied between the different professional groups with most but not all dietitians reporting the greatest awareness of guidelines and GPs the least (p = 0.001). Those HCPs with a greater awareness of guidelines had received training (p = 0.001) and were more likely to report complete confidence in providing nutritional advice (p = 0.001). Conclusion Whilst HCPs discuss nutrition with cancer patients and may provide information, many lack an awareness of guidelines and confidence in providing nutritional advice. To ensure consistency of practice and improvements in patient care, there is scope for enhancing the provision of appropriate nutrition education and training.
ObjectivesThe purpose of this systematic review is to explore whether health equity audits (HEAs) are effective in improving the equity of service provision and reducing health inequalities.DesignThree databases (Ovid Medline, Embase, Web of Science) and grey literature (Opengrey, Google Scholar) were systematically searched for articles published after 2000, reporting on the effectiveness of HEA. Title and abstracts were screened according to an eligibility criteria to identify studies which included a full audit cycle (eg, initial equity analysis, service changes and review). Data were extracted from studies meeting the eligibility criteria after full text review and risk of bias assessed using the ROBINS-I tool.ResultsThe search strategy identified 596 articles. Fifteen records were reviewed in full text and three records were included in final review. An additional HEA report was identified through contact with an author. Three different HEAs were included from one peer-reviewed journal article, two published reports and one unpublished report (n=4 records on n=3 HEAs). This included 102 851 participants and over 148 practices/pharmacies (information was not recorded for all records). One study reviewed health equity impacts of HEA implementation in key indicators for coronary heart disease, type 2 diabetes and chronic obstructive pulmonary disease. Two HEAs explored Stop Smoking Services on programme access and equity. All reported some degree of reduction in health inequalities compared with prior HEA implementation. However, impact of HEA implementation compared with other concurrent programmes and initiatives was unclear. All included studies were judged to have moderate to serious risk of bias.ConclusionsThere is an urgent need to identify effective interventions to address health inequalities. While HEAs are recommended, we only identified limited weak evidence to support their use. More evidence is needed to explore whether HEA implementation can reduce inequalities and which factors are influencing effectiveness.Trial registration numberThe study was registered prior to its conduction in PROSPERO (CRD 42020218642).
Hospital Southampton NHS Foundation Trust Southampton SO16 6YD.People diagnosed with cancer often experience nutrition-related problems and they do not receive consistent evidence-based advice (1) . Studies indicate that just 30-60 % of cancer patients who were at risk of malnutrition received nutritional support (2) . The National Institute for Health Research Cancer and Nutrition infrastructure collaboration (http://cancerandnutrition.nihr.ac.uk) sought to determine the breadth and diversity of practice across professional groups in identifying and assessing the need for nutritional support. We report the findings of a survey aimed at understanding clinicians' awareness and current practice for screening and assessing nutritional status, the provision of nutrition advice and use of relevant nutrition support guidelines, and training needs.A national cross-sectional online survey comprising 21 questions was sent to health care professionals via professional groups, networks and personal contacts. Of the 610 responses received, there were 191 nurses (31 %), 152 dietitians (25%), 187 doctors (31 %) and 54 Speech and Language Therapists (9 %) and 26 from 'other'.The majority of respondents (77 %) indicated that they used a screening tool to identify people at risk of malnutrition in the in-patient settings but only 29 % reported screening for malnutrition in the out-patient setting. The Malnutrition Universal Screening Tool was the most widely reported tool for screening, used by 68 % of dietitians, 61 % of nurses and 39 % of doctors for inpatient settings. Overall, 33 % of respondents systematically collect nutritional data of their cancer patients, with dietitians most likely to do so (64 %). Of those that do collect data, the principle routine measurements were weight, height and BMI (81 %), weight loss (63 %), appetite (82 %) and risk of poor intake (62 %). The most common concerns raised with health professionals were loss of appetite, nausea/ vomiting, weight loss, change in taste/smell, constipation and fatigue. Dietitians reported that they all discuss nutrition with their patients, had been trained (80 %) and were completely confident (70 %) in providing advice on nutritional care in cancer and were aware of recent guidelines (79 %). In contrast, although doctors (88 %) and nurses (96 %) discussed nutritional concerns with their patients, few were completely confident in giving that advice (doctors 2 %, nurses 4 %) and most had not received any formal training in nutritional care and were generally unaware of guidelines for the nutritional care of cancer patients (doctors 81 % and nurses 70 %). There was a perceived need for further training in relation to nutrition and cancer from all groups (dietitians 48 %; doctors 66 %, nurses 81 %) particularly on dietary advice for specific cancers and cancer stage (70 %), assessment of nutritional status (63 %), alternative dietary approaches (57 %) and dietary supplements (47 %).These findings show that whilst health professionals discuss nutritional matters with ...
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