Supportive Care in Cancer · 5 authors, 6 centres
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This qualitative case study nested within an 18-week RCT analyzed dietitian-patient interactions delivered by telephone or mobile app to patients newly diagnosed with upper gastrointestinal cancer. The central result was that dietitians adopted roles of collaborative problem-solving for empowerment, care navigation with anticipatory guidance, and psychosocial support, but nutrition impact symptom management remained an unmet need beyond dietitian scope of practice.
This qualitative case study was nested within a three-arm RCT (the TEND study) exploring an 18-week intensive nutrition counselling intervention for patients newly diagnosed with upper gastrointestinal cancer. The case comprised six participants, from whom 51 telephone conversations (17 hours), 244 written messages, and four post-study interviews were inductively coded and thematically analyzed. Data from 20 additional post-study interviews were analyzed using the derived coding framework to explore unmet needs. Three key dietitian roles were identified: regular collaborative problem-solving to encourage patient empowerment, reassuring care navigation including anticipatory guidance, and rapport building through psychosocial support encompassing empathy, reliable care, and positive perspective. Despite intensive dietitian counselling, nutrition impact symptom management was identified as a core unmet need because it required medication management beyond the dietitian's scope of practice. Findings suggest dietitians can deliver psychosocial support and care navigation remotely without face-to-face contact, and that extended or advanced dietitian practice roles may help address high unmet needs in cancer nutrition care. Limitations include the post hoc analytic approach and a small case sample.
