Background and aim
The development and implementation of evidence-based cancer nutrition models of care into clinical practice is challenging and pragmatic guidance is lacking. This scoping review aimed to identify the core elements and principles of dietitian-led nutrition models of care for people with cancer.
Methods
MEDLINE Complete, CINAHL and Embase were systematically searched between 1 January 2003 - 8 November 2023. Studies were eligible for inclusion if they reported on the implementation or evaluation of a nutrition model of care for adults with any cancer diagnosis. The protocol was prospectively registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/RQVHJ) on 7 November 2023.
Results
The search identified 4599 papers, 26 studies met inclusion criteria. Studies were primarily conducted in Australia (73.1%), within a hospital (96.2%), metropolitan setting (92.3%) and with various cancer diagnoses. Most studies described a nutrition screening process, 50% used a valid assessment tool and 4 studies used an implementation framework. Studies described provision of care by a dietitian (n=25), across the care continuum (76.9% after treatment up to 3-6 months), primarily conducted in the outpatient setting (n=24) and lesser in the inpatient setting (n=11) and frequently face-to-face (n=24) [phone (n=14), telehealth (n=3)]. Ten core elements were identified that underpinned the models of care including: care driven by a care pathway, protocol or clinic (100%); dietitian-led (100%); flexible and integrated (100%); with multi-directional communication (96.2%); accessible (92.3%); stratified by risk (88.5%); multidisciplinary (80.8%); across different care and settings (76.9%); supported by training/education (46.2%) and data integration (23.1%).
Conclusion
Dietitian-led cancer nutrition models of care literature was primarily limited to metropolitan, hospital settings and many lacked valid nutrition assessment tools. Ten core elements were identified that underpinned nutrition care. There is great potential for an evidence-based model of nutrition care to improve the implementation and embedding of high-quality nutrition elements into the cancer pathway.