Aim: At Peter MacCallum Cancer Centre, patients with head and neck (H&N) cancer receiving curative intent (chemo)radiation are managed in a twice-weekly multidisciplinary clinic. Patients are seen by a dietitian weekly during treatment and fortnightly up to six weeks post treatment. However, dietitians have limited time to manage complex H&N patients. Nutrition assistants (NA) work in the inpatient and ambulatory settings, performing malnutrition screening and basic nutrition intervention for low nutrition risk patients. This study aimed to evaluate the effectiveness of implementing the NA role for screening and intervention of lower risk patients in the multidisciplinary head and neck clinic.
Methods: A training module and model of care were established to upskill the NA and guide the screening and interventions to be undertaken. A pre-test post-test design was utilised comparing outcomes pre- and post-implementation of the NA role. Outcomes included proportion of dietitian time spent with high risk patients, weight change during and post-radiotherapy and patient satisfaction assessed at 6-weeks post-treatment using a valid satisfaction with nutrition services questionnaire.
Results: Forty-three patients were included pre-implementation and 48 patients post-implementation with 21 (44%) of patients identified for NA screening/ intervention. Proportion of dietitian time spent with high risk patients improved post-implementation (84% vs. 62%). Mean weight change was similar between the groups during radiotherapy (-5.6% vs. -4.7%, p=0.3) and up to 4 weeks post-radiotherapy (-6.6% vs. -6.49%, p=0.9). Significant improvement in overall patient satisfaction (4.0 + 1.1 vs 4.6 + 0.61, p=.03), patient perceived benefit (3.8 + 0.69 vs 4.4 + 0.62, p<.01) and dietitian interpersonal skills (3.91 + 1.1 vs 4.6 + 0.55, p=.02) were observed post-implementation.
Conclusions: Nutrition assistants are an effective workforce to manage low risk patients in a multidisciplinary H&N treatment clinic demonstrating maintenance of clinical outcomes, improved efficiency and increased patient satisfaction.