Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Embedding person-centred oncology nutrition in practice: Implementation of electronic patient-led nutrition screening in the ambulatory cancer care setting (#406)

Elise Treleaven 1 2 , Claire Blake 1 2 , Adrienne Young 1 2 3 , David Wyld 4 , Jenni Leutenegger 4 , Teresa Brown 1 2 5
  1. Department of Dietetics & Food Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  2. Nutrition Research Collaborative, Brisbane, Queensland, Australia
  3. Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  4. Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  5. School of School of Human Movement & Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia

Aims: Malnutrition prevalence in cancer patients is reported as high as 80%; however staff-led screening and referral pathways for nutrition care can be suboptimal. Patient-led screening has been identified as a feasible solution, following local research demonstrating that patient self-screening using the Malnutrition Screening Tool (MST) is valid and well-accepted in Oncology.  This study aimed to design, implement, and evaluate patient-led malnutrition screening and referral pathways as routine practice.

Methods: A pre and post implementation prospective cohort study was conducted at a single, quaternary Cancer Care Service, utilising the i-PARIHS implementation framework with a range of stakeholders (clinicians, managers and consumers). The electronic patient-led nutrition screening tool (PLNST) was co-designed and rigorously tested with consumers. The tool is sent to patients via SMS on the day of their systemic therapy. Patients can opt-out or decline to respond at any time and nurse-led screening practice continued in parallel.

Study participants were consecutive adult patients presenting for initial systemic therapy for any solid tumours or haematological malignancies within a 1-month period in the pre (September 2018) and post (September 2020) groups. Self-screening and referral rates were collected from the electronic medical record during the 3-month follow-up period.

Results: Study participants included n=41 in the pre-PLNST and n=47 post-PLNST cohorts. Overall screening completion rates improved from 73% to 82%. In the post group, 70% (n=33) of patients completed the PLNST at any time and 47% (n=22) completed multiple self-screens. The PLNST identified 45% (n=15/33) at risk of malnutrition (compared to 21% by nurse-led screening) and 52% (n=17/33) of patients requested dietetic input. In the 12-months post-implementation, dietetic activity increased by 192%.

Conclusions: Patient-led malnutrition screening was successfully implemented as routine practice in the Oncology Day Therapy Unit using an implementation science approach. Innovative models of care (including group nutrition education) are being investigated to meet increased patient-driven service demands.