Evaluating the effectiveness of a nutrition assistant role in a head and neck cancer clinic

Abstract

Acute toxicities secondary to (chemo)radiation for head and neck cancer can substantially impact nutritional intake. Nutrition is usually managed by dietitians, although time constraints may limit capacity to sufficiently deal with complex nutritional issues. The aim of the present study was to determine the effectiveness of a nutrition assistant performing screening and intervention of patients in a multidisciplinary head and neck clinic. A model of care was developed to guide nutrition assistant practice within the clinic, with training provided to nutrition assistants prior to the clinic's implementation. Outcomes, including amount of dietitian time managing high risk patients, weight change over the duration of treatment, timing of initiation of enteral feeding and patient satisfaction were compared with pre- and post-implementation of the nutrition assistant role. Ninety-one patients were included, 43 pre-implementation and 48 post-implementation. Overall, (n = 21, 44%) of patients met criteria for nutrition assistant screening or intervention. Mean weight change between groups was comparable both during (-5.6% vs -4.7%, P = 0.3) and post-radiotherapy (-6.6% vs -6.49%, P = 0.9). Following implementation of the role significant improvement was found for overall patient satisfaction (4.0 ± 1.1 vs 4.6 ± 0.61, P = 0.03), and the dimensions: patient-perceived benefit (3.8 ± 0.69 vs 4.4 ± 0.62, P < 0.01) and dietitian/nutrition-assistant interpersonal skills (3.91 ± 1.1 vs 4.6 ± 0.55, P = 0.02). The nutrition assistant role resulted in improved patient satisfaction and maintenance of nutritional outcomes demonstrating the effectiveness of this role in supporting the management of head and neck cancer patients within a multidisciplinary treatment clinic.