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“There’s a lot of talent in the room but it’s only really the medical talent that gets heard”: a qualitative exploration of multidisciplinary clinicians’ perspectives of optimal nutrition care of patients with head and neck cancer

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Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

The high prevalence of malnutrition in patients with head and neck cancer (HNC) negatively impacts outcomes. The best-available evidence has been published in clinical nutrition guidelines; however, translation into practice has lagged.

Aim

This project aimed to explore multidisciplinary team (MDT) clinicians’ perspectives regarding barriers and enablers to best-practice nutrition care in order to inform the design of a new model of care.

Method

Qualitative interviews were conducted with clinicians who were purposively sampled from a major HNC tertiary referral centre in Sydney, Australia. To elicit information regarding barriers and facilitators to change, a semi-structured interview schedule was developed, interviews were transcribed verbatim and analyzed employing an inductive thematic approach. The Consolidated Framework for Implementation Research (CFIR) was used to guide data analysis and interpretation of key themes identified.

Results

Nineteen participants (11 supportive care and eight medical clinicians) representing allied health, medical, and nursing disciplines participated. Five key themes were identified: (1) acknowledgement of dietetics expertise and access to resources to deliver nutrition care; (2) proactive versus reactive nutrition care; (3) integrated and coordinated care—“The One Stop Shop”; (4) MDT favours the medical model; and (5) leadership—within disciplines, within the MDT.

Conclusions

MDT clinicians expressed similar views regarding delivering optimal nutrition care to this high nutritional risk patient group. However, perspectives differed at times between medical and supportive care clinicians, attributable to perceptions that current service structure favours the medical model. In order to design and deliver an evidence-based model of care, specific strategies will be required to ensure: early and ongoing access to expert nutrition care; nutrition care processes are proactive; integrated and coordinated care; and leadership, both intra- and inter-disciplinary. This novel exploration of MDT clinicians’ views provides supporting evidence that multi-component implementation strategies comprising individual, team and system-level approaches will be essential to leverage sustainable change.

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Acknowledgements

The study investigators wish to thank the multidisciplinary clinicians of the head and neck oncology services of Royal Prince Alfred Hospital and Chris O’Brien Lifehouse for generously giving their time and sharing their experiences to inform new models of nutrition care and improve service delivery for those living with head and neck cancer.

Availability of data and material

The data that support the findings of this study as well as the ethical approvals regulating this research are available on request from the corresponding author.

Code availability

Not applicable.

Funding

Chief investigator (M Findlay) was supported by a Translating Research into Practice Fellowship from The National Health and Medical Research Council and Cancer Institute New South Wales, Australia [APPID#1092508].

Author information

Authors and Affiliations

  1. Cancer Services, Royal Prince Alfred Hospital, New South Wales, Australia

    Merran Findlay & Kathryn White

  2. Chris O´Brien Lifehouse, Camperdown, New South Wales, Australia

    Merran Findlay

  3. Sydney Catalyst Translational Cancer Research Centre, University of Sydney, Sydney, New South Wales, Australia

    Merran Findlay, Tim Shaw, Kathryn White & Nicole M. Rankin

  4. School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia

    Judith Bauer

  5. Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia

    Tim Shaw

  6. Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Kathryn White & Michelle Lai

  7. Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia

    Nicole M. Rankin

Authors
  1. Merran Findlay
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  2. Judith Bauer
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  3. Tim Shaw
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  4. Kathryn White
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  5. Michelle Lai
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  6. Nicole M. Rankin
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Contributions

Conceptualization: Merran Findlay, Judith Bauer, Nicole Rankin, Tim Shaw, and Kathryn White; Methodology: Merran Findlay, Judith Bauer, Nicole Rankin, Tim Shaw, and Kathryn White; formal analysis and investigation: Merran Findlay, Nicole Rankin; writing—original draft preparation: Merran Findlay and Michelle Lai; writing—review and editing: Merran Findlay, Nicole Rankin, Judith Bauer, Michelle Lai, Tim Shaw, and Kathryn White; funding acquisition: Merran Findlay, Judith Bauer, and Tim Shaw; resources: Merran Findlay; supervision: Judith Bauer, Nicole Rankin, Tim Shaw, and Kathryn White.

Corresponding author

Correspondence to Merran Findlay.

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Informed consent to participate was obtained from all participants.

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Informed consent for publication in a peer-reviewed journal was obtained from all participants. All authors approved the final version of the manuscript for publication.

Disclaimer

The funding body did not influence the study procedures or interpretation of results.

Conflicts of interest

The authors have no conflict of interest to disclose.

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Findlay, M., Bauer, J., Shaw, T. et al. “There’s a lot of talent in the room but it’s only really the medical talent that gets heard”: a qualitative exploration of multidisciplinary clinicians’ perspectives of optimal nutrition care of patients with head and neck cancer. Support Care Cancer 29, 6399–6409 (2021). https://doi.org/10.1007/s00520-021-06162-4

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  • DOI: https://doi.org/10.1007/s00520-021-06162-4

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