Oncology dietitians’ experiences of implementing a behaviour change intervention for patients with head and neck cancers receiving radiotherapy

Scope: Malnutrition and weight loss are common in patients with head and neck cancers (HNC) and are associated with increased morbidity and mortality. Dietetic counselling is integral to treatment, but many patients are non-compliant with dietetic advice. The Eating as Treatment (EAT) intervention aimed to improve nutritional status among patients with HNC receiving radiotherapy, by combining dietetic advice with strategies drawn from cognitive behaviour therapy (CBT) and motivational interviewing (MI). The EAT intervention was previously evaluated using a cluster randomised controlled trial across four sites in Australia and was associated with improved patient nutritional status. Purpose: The purpose of this study was to examine the experiences of dietitians who implemented the EAT intervention. The primary goal was to inform future efforts to improve nutritional status in patients with HNC, including the potential enhancement and broader dissemination of the EAT intervention. A secondary goal was to contribute to the broader professional dialogue regarding the use of CBT and MI strategies in dietetics. Methodology: Semi-structured telephone interviews were conducted with dietitians. A stratified purposive sampling strategy was initially adopted, in an attempt to recruit dietitians from all sites. Seventeen individuals were approached. Three were ineligible, two were on leave, one declined and seven did not respond. Four dietitians from two sites participated. Interviews were audio-recorded, transcribed and subjected to thematic analysis. Results: Dietitians valued the practical training they received regarding the EAT intervention. They were able to integrate the intervention into their practice with patients who had HNC, although some aspects of the intervention or the clinical trial were challenging. On the whole, dietitians reported behaviour change strategies were often useful with this patient group, and supported the value of behaviour change strategies in dietetics more broadly. Dietitians highlighted several opportunities for enhancing the EAT intervention or the accompanying training. Conclusions and Implications: The limitations of this study include a small sample size, the fact that not all trial sites were represented, and the reliance on dietitians’ recall up to two years post-intervention. While the results cannot be generalised more broadly because of these limitations, the findings do highlight several considerations that may be relevant to the use of CBT and MI in dietetic practice and to improving nutritional status in patients with HNC who are receiving radiotherapy.