Teaching Nutrition Integration: MUST Screening in Cancer

Abstract

Rationale. Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening.Methods. Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number.Results. RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance ( coefficient) with dieticians was found with RT technicians' use of the MUST (p < .002) and percentage weight loss determination by physicians (p < .001).Conclusions. We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities. The Oncologist 2011;16: 239 -245

Nutrition in Cancer Patients

“…The adequate tool for screening undernutrition should be brief and easy to fill, inexpensive, highly sensitive and have good specificity [25]. MUST (Malnutrition Universal Screening Tool) and NRS-2002 (Nutritional Risk Screening-2002) are considered suitable [28,29,30]; the MNA (Mini Nutritional Assessment) is a suitable tool for nutritional assessment in the senior population [19,23].…”

Influence of pretreatment ideal body weight percentile and albumin on prognosis of nasopharyngeal carcinoma: Long-term outcomes of 512 patients from a single institution

“…Tsai et al reported the use of the mini nutritional assessment in predicting the nutritional status of patients with liver cancer. Malnutrition Universal Screening Tool was suggested by Boléo–Tomé et al These methods, often including anthropometric, dietary, and subjective assessment, ensure an accurate and comprehensive evaluation. However, most of them are complex and time‐consuming for clinicians.…”

Barriers in Nursing Practice in Cancer Cachexia: A Scoping Review

“…Some programs have focused on how to use a specific assessment tool (e.g., MUST). [ 33 35 ] Other programs cover artificial hydration therapy and general nutrition management in cancer patients. [ 32 34 ] Education effectively increased knowledge and confidence[ 32 34 ] but did not improve compliance with nutritional assessment after the intervention.…”

“…[ 32 34 ] Education effectively increased knowledge and confidence[ 32 34 ] but did not improve compliance with nutritional assessment after the intervention. [ 33 35 ] Heterogeneity in types of interventions or outcomes existed, and the participants' age and background varied among studies.…”