Core elements and principles of nutrition models of care for people with cancer: A scoping review

Abstract

Background and aims: The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of nutrition models of care for people with cancer.

Methods: MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003-8 November 2023. Studies were eligible for inclusion and data extraction if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.

Results: The search identified 4599 papers, 28 studies met inclusion criteria. Studies were primarily conducted in Australia (71.4 %), within a hospital (96.4 %), metropolitan setting (89.3 %) and with various cancer diagnoses. Most studies described a nutrition screening process and 50 % used a valid and reliable assessment tool. Studies described provision of direct care by the dietitian (n = 26), primarily conducted in the outpatient setting (n = 26) and lesser in the inpatient setting (n = 12), and frequently face-to-face (n = 25) [phone (n = 14), telehealth (n = 3)]. Ten core elements were identified that underpinned the models of care including: timely care driven by a care pathway, protocol or clinic (100.0 %); nutrition expertise and leadership (100.0 %); flexible and integrated (100.0 %); with multi-directional communication (96.4 %); accessible (92.9 %); stratified by risk (89.3 %); multidisciplinary engagement (85.7 %); across different care time-points and settings (85.7 %); supported by training/education (50.0 %) and data integration (25.0 %).

Conclusions: Nutrition expert-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care, with the most utilised being: timely care driven by a care pathway, protocol or clinic; nutrition expert-led; flexible and integrated; with multi-directional communication; accessible; and stratified by risk. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.

Keywords: Cancer; Care pathway; Dietitian; Health service research; Model of care; Nutrition.