Exploring nutritional therapy practitioner perspectives on working with people affected by cancer

Abstract

Introduction Nutrition can impact significantly on cancer occurrence, recurrence and survival. Many people affected by cancer seek individualised nutrition advice, but globally this remains an unmet need for many. Nutritional therapy (NT) practitioners provide personalised nutritional care, including complementary care for people affected by cancer. Until now, there is little documentation internationally of NT practice with people affected by cancer. This mixed methods study explores NT practitioners’ perspectives, to inform professional development needs to ensure safe evidence-based practice with people affected by cancer. Methods An on-line anonymised survey was open to all UK registered NT practitioners. Data was collected on practitioner characteristics, patterns of practice with people affected by cancer and perceived barriers to that practice, the use of research evidence in practice, and practitioners’ perceived needs for training and support. Data on practitioner characteristics were compared between practitioners who work with people affected by cancer (CP) and those who do (NCP). Preliminary themes emerging from the survey informed the second phase, in which semi-structured individual interviews (n=21) and one group interview were used for in depth exploration of practitioner perspectives on practice with people affected by cancer. Topics explored included rewards and motivation, barriers and challenges to practice, and professional development needs. Interview transcripts were analysed thematically, using Framework methodology. Results 274/888 (31%) UK registrants completed the survey. CPs were more likely than NCPs to have additional health and life science (HLS) qualifications (p=0.009) and to have been in practice for longer (practice for more than 10 years, p=0.012). 80% survey respondents overall, including CPs, worked alone for at least some of the time. Practitioners experienced reward in empowering people affected by cancer to make dietary changes, for some their own cancer journey or witnessing cancer in a loved one was a motivator. Significant challenges and barriers to practice included managing the emotional and psychological demands of working with people affected by cancer, lack of recognised specialist training and resources, and lack of engagement with or perceived opposition from oncologists. To overcome these barriers, professional development needs identified were firstly specialist clinical supervision, mentoring and networking to overcome isolation and share best practice. Secondly, specialist training and resources to facilitate accessing, critically appraising and communicating evidence in practice are required. Thirdly, engagement with mainstream professionals working in cancer care requires improvement. Conclusions This is first detailed exploration of NT practitioner perspectives on working with people affected by cancer and the data have revealed important areas for developing training and support. Findings are informing development of frameworks for practitioner support including clinical supervision and specialist training, to support safe evidence-based practice and better communication and integration with mainstream cancer care. Future exploration of NT practitioners’ perspectives should assess the impact of proposed professional developments highlighted here. Further exploration of perspectives of mainstream healthcare professionals with whom nutritional therapy practitioners may engage is also recommended.