The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis

Purpose: This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile app to people newly diagnosed with upper gastrointestinal (UGI) cancer to 1) elucidate the roles of the dietitian during intervention delivery and 2) explore unmet needs impacting nutritional intake. Methods: Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included: fifty-one telephone conversations (17 hours), 244 written messages and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n=20) to explore unmet needs. Results: Themes describing the roles of the dietitian were: regular collaborative problem solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. Conclusion: Delivery of nutrition care via the telephone or an asynchronous mobile app to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychological support. Limitations in dietitians’ scope of practice identified unmet patient’s needs in nutrition impact symptom management, which requires medication management. Trial Registration 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).