Discussion
UGI cancer, cancer, cancer symptoms
CANCER
This study explored the patient-dietitian experience during an 18-week nutrition intervention delivered using the telephone or a mobile application to people newly diagnosed with UGI cancer to elucidate the roles of the dietitian during the intervention. This study identifies important components of delivering supportive care via different modes for those undergoing treatment for UGI cancer. The roles of the dietitian were characterised by regular collaborative problem-solving to encourage empowerment, a reassuring care navigator (including anticipatory guidance), and rapport building via reliable psychosocial support. This analysis also revealed that role limitations led to unmet needs as the dietitian was constrained by poorly managed cancer symptoms that negatively impacted oral intake and subsequently weight stability.This study demonstrated that rapport can be built within the patient-dietitian relationship without face-to-face communication. It is well established that psychosocial support, for example empathy, compassion, positivity, reassurance, and care, is valued by patients in the dietitian-patient relationship [The dietitian’s role as a care navigator and multidisciplinary team member was limited by the scope of the RCT as the dietitian could only recommend to the patient when and where to seek help. It was not within the scope of the intervention for the dietitian to actively contact patients’ individual healthcare team to advocate, discuss, and collaborate to optimise symptom and medication management, distress, and treatment progression. This highlights the importance of multidisciplinary teams being critical in cancer management and the need for the dietitian to be part of the team. Improving the safety and quality of health service provision to ensure that it is provided by the right person, at the right time, in the right place, and for the right cost is essential [The case study design is a strength of this work; many studies have short-term interventions and provide little insight into how the intervention works. The use of within-intervention conversations was also a strength of this study as this data is not limited by memory or response bias. This detailed analysis reveals the roles of the dietitian needed to maximise oral intake during cancer treatment; furthermore, it reveals that sub-optimal cancer symptom management remains a significant barrier to achieving optimal oral intake, even when under the intensive care of a dietitian. A limitation is that this was a post hoc analysis, precluding direct questions of the patient and dietitian perspective of the dietitian’s role.