Patient, family and carer experiences of nutritional screening: a systematic review

Abstract

Background: Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers.Methods: A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception -July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes.Results: Nine studies, including five qualitative interview papers, were included.Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change.Conclusions: Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.

Accuracy of three tools for malnutrition diagnosis in hospitalised patients: Comparison to subjective global assessment

“…46 In addition, considering that misunderstanding, caused by a lack of knowledge regarding the causes and consequences of malnutrition, resulted in reduced risk perception and disbelief or the rejection of screening results in a recent systematic review, it is necessary to educate vulnerable groups regarding the role of nutritional screening, malnutrition, and its causes and consequences, combined with a tailored approach for providing nutritional advice. 55…”

“…Furthermore, the performance of both tools in community should be tested, considering that the best way to carry out screening in the community for effective identification of malnutrition is one of the ten priorities according to the James Lind Alliance Priority setting for adult malnutrition 46 . In addition, considering that misunderstanding, caused by a lack of knowledge regarding the causes and consequences of malnutrition, resulted in reduced risk perception and disbelief or the rejection of screening results in a recent systematic review, it is necessary to educate vulnerable groups regarding the role of nutritional screening, malnutrition, and its causes and consequences, combined with a tailored approach for providing nutritional advice 55 …”

The experience of family caregivers of patients receiving home nasogastric tube feeding in China: A descriptive qualitative study

“…This may involve regaining control over their daily lives 33 . Understanding the effectiveness of nutrition and its role in disease contributed to caregivers participating in decision‐making 34 . Information‐giving needs to include the associated evidence to ensure that a decision is made in line with their own values, 35 which facilitates decision‐making involving caregiver input.…”

“… 33 Understanding the effectiveness of nutrition and its role in disease contributed to caregivers participating in decision‐making. 34 Information‐giving needs to include the associated evidence to ensure that a decision is made in line with their own values, 35 which facilitates decision‐making involving caregiver input. Important findings showed that family caregivers begin to realise the difficulty of this task and the responsibility of well‐being of patients being in their hands.…”

Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

“…Consistent with a patient-centred care approach, patients should be adequately informed about the purpose and outcome of risk screening. A 2020 systematic review found that while most patients were accepting of nutrition screening, many did not understand its purpose or its results, which caused some to disbelieve or disregard their risk and was a barrier to patients enacting dietary advice [ 121 ]. This highlights the importance of engaging patients in the care process and keeping them informed to make health care decisions.…”