Failure to Thrive: A Qualitative Study of Registered Dietitian Nutritionists' Perspectives on Barriers to Timely Nutrition Support in Gastrointestinal Cancer.
Malnutrition affects about 61% of patients with gastrointestinal (GI) cancers, yet timely, registered dietitian nutritionist-led care is often delayed or uneven across settings. To identify registered dietitians' (RDs) perceived barriers to timely nutrition support in GI oncology within a multisite...
| Publicado en: | Journal of the Academy of Nutrition & Dietetics Vol. 126; no. 9 |
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| Autores principales: | , , , , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Elsevier B.V.
Sep2026
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=195836762&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 195836762 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 22122672 DUQY jtl: Journal of the Academy of Nutrition & Dietetics issn: 22122672 maglogo: N pubinfo: dt: Sep2026 vid: 126 iid: 9 pid: 467 pub: Elsevier B.V. place: New York, New York artinfo: ui: 195836762 195836762 195836762 10.1016/j.jand.2026.156332 195836762 ppct: 1 formats: tig: atl: Failure to Thrive: A Qualitative Study of Registered Dietitian Nutritionists' Perspectives on Barriers to Timely Nutrition Support in Gastrointestinal Cancer. aug: au: Lal, Trisha Moody, Daria Chiratanagandla, Rishi Chakraborty, Natalie N. Davey, Christine Horvat Bora, Samudragupta Eitan, Shira LeJuene, Amy Dunbar, Amy Hoehn, Richard S. affil: Division of Surgical Oncology, University Hospitals, Cleveland Medical Center, Cleveland, Ohio sug: subj: Dietitians Psychosocial Factors Nutritionists Psychosocial Factors Attitude of Health Personnel Evaluation Gastrointestinal Neoplasms Nutritional Support Psychosocial Factors Treatment Delay Psychosocial Factors Human Qualitative Studies Multicenter Studies Academic Medical Centers Descriptive Research Semi-Structured Interview Adult Middle Age Female Thematic Analysis Health Services Accessibility Referral and Consultation Time Continuity of Patient Care Health Labor Supply Emotions Workload Promotion and Tenure Multidisciplinary Care Team Personnel Staffing and Scheduling Early Intervention Psychosocial Factors Hand Off (Patient Safety) Health Resource Allocation Preoperative Education Nutrition Education Cancer Patients Failure to Thrive Prevention and Control Malnutrition Prevention and Control Adult: 19-44 years Middle Aged: 45-64 years Female ab: Malnutrition affects about 61% of patients with gastrointestinal (GI) cancers, yet timely, registered dietitian nutritionist-led care is often delayed or uneven across settings. To identify registered dietitians' (RDs) perceived barriers to timely nutrition support in GI oncology within a multisite academic health system. Qualitative descriptive study using semi-structured interviews, supplemented by a brief survey to characterize participants and practice context. Seven RDs practicing across inpatient and outpatient services at a main campus and satellite sites (all non-Hispanic White women; median age 45 years, interquartile range [IQR] 37 to 52 years). Perceived barriers to timely nutrition support; theme salience by clinician characteristics (years in practice, GI caseload, and number of facilities). Inductive thematic analysis by 2 coders with iterative codebook refinement and consensus; descriptive summaries of survey items; joint display mapping participant attributes to theme salience (0 = not mentioned, 1 = mentioned, 2 = strongly emphasized) and a salience-weighted score (the sum of the 5 theme ratings; range = 0 to 10). Five barriers emerged: Access, Referral Timing, Coordination, Workforce Constraints, and Emotional Burden. Theme salience peaked among clinicians covering 2 or more facilities (mean salience-weighted score = 9.5 out of 10). In the joint display (years in practice, GI caseload, and the number of facilities), Access, Coordination, and Workforce appeared across all subgroups. All RDs endorsed a multidisciplinary team focused on nonmedical barriers. System-level obstacles, particularly access limitations, coordination gaps, and staffing constraints, delay timely nutrition support in GI oncology, with multisite coverage intensifying these challenges. Findings highlight actionable leverage points for implementation, including standardized early referral triggers, structured cross-setting handoffs, streamlined resource navigation, and workforce supports. In response, a preoperative nutrition handout paired with an automatic RD referral at the surgical preoperative visit was initiated at the study institution. Prospective studies should assess the influence on nutritional status, treatment tolerance, and patient-reported outcomes. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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