The Dietetic Consultation: an Illuminative Evaluation

Understanding the Experience of the Dietetic Consultation and the Perceptions of Its Value From the Perspective of Nutritionally Vulnerable Older Patients, Dietitians and Other Key Stakeholders: an Illuminative Evaluation

This study aims to understand the experience of the dietetic consultation from the perspective of nutritionally vulnerable older patients receiving oral nutrition support and dietitians, as well as other key stakeholders involved in the process of such a consultation.

Malnutrition is prevalent and increases the risk of health complications and socioeconomic burden. Patients with malnutrition are often older patients with complex needs and therefore may require specialist knowledge and skills to provide nutritional support. Dietitians are uniquely skilled to assess the multiple factors that underpin diet and to tailor nutritional support, which could help improve outcomes. Although the causes of malnutrition are complicated, its treatment typically involves oral nutritional supplements, dietary advice or food-based interventions, either separately or in combination.

Effectiveness of the various oral nutritional support interventions has been studied, with the findings on food-based interventions suggesting more research is needed and the widespread research on ONS suggesting contradictory results and interpretations. Despite this, the factors responsible for these inconsistencies have not been identified. There are no studies so far that have examined the patient experience of the consultation with the dietitian in the context of nutritional support. Although the patient experience of consultations is increasingly being recognised as an important part of investigating their effectiveness in healthcare, to date, there are a number of limitations in this literature, leaving the role of the patient experience in dietetic consultations for the management of malnutrition, poorly understood. It's probable that this is one contributing factor to the variation observed in the literature.

A review of the literature indicates a need for exploration of the patient experience and its possible impact on the success or failure of the dietetic encounter. This study aims to address some of the knowledge gaps. The use of qualitative interviews will allow an in-depth understanding of the experience of the dietetic consultation for the provision of nutrition support and will utilise an overall illuminative evaluation approach to broaden that understanding by considering data from various sources. Participants will include older patients who are considered nutritionally vulnerable, their consulting dietitians and patient-nominated key stakeholders. Four clinical settings within the Trust where dietitians would often see patients for nutritional support will be included.

Study Overview

• Status: Completed
• Conditions: Malnutrition
• Intervention / Treatment: Other: Interviews, key stakeholders, documents; Other: Observations, documents

• Study Type: Observational
• Enrollment (Actual): 45

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, SE1 9NH
    • King's College London

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 60 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Patients:

Older patients malnourished or at risk of malnutrition requiring oral nutritional support from a dietitian in a range of clinical settings.

Dietitians:

Consulting registered dietitian providing the nutritional advice to patient above

Key Stakeholders:

Up to 2 optional patient-nominated key stakeholders who are involved in the dietetic consultation and success of the dietetic intervention e.g. other HCP, carer or family member.

Description

Inclusion Criteria:

Patients:

• Adults (aged > 60 years)
• National Health Service (NHS) number
• Capable of giving informed consent
• Able to communicate well in English
• Nutritionally vulnerable according to the Nutrition Screening Tool in use at the NHS Trust prompting referral to a dietitian
• Likely to receive a form of oral nutrition support in the management of malnutrition
• A variety of the patient characteristics detailed earlier will be included where possible
• Consents to having their qualitative interview audio-recorded (Group 2)

Dietitians:

• Consulting dietitian providing the nutritional advice to patient above
• Employee of the NHS Trust and member of the Nutrition & Dietetic team
• Minimum of three different dietitians across the healthcare settings to be included
• Consents to having their qualitative interview audio-recorded

Key Stakeholders:

Up to 2 optional patient-nominated key stakeholders who are involved in the dietetic consultation and success of the dietetic intervention e.g. other HCP, family member, carer or friend. Their criteria for inclusion will include:

• Nominated by the patient (from Group 2) participating in the study
• Involved in some aspect of the implementation of goals agreed between the patient and dietitian during the consultation i.e. the nutritional intervention
• Available for separate interview at a mutually agreed location
• Capable of giving informed consent
• Able to communicate well in English
• Consents to having their qualitative interview audio-recorded

Exclusion Criteria:

Patients:

• Participated or due to participate in another aspect of the study i.e. a patient will not be recruited to participate in consultation observations if they have already been or due to be recruited to take part in the qualitative interviews and vice versa.
• Outside of stated age range for inclusion
• Incapable of giving informed consent
• No National Health Service (NHS) number
• Unable to communicate well in English
• Not considered nutritionally vulnerable according to Nutrition Screening Tool
• Not referred to a dietitian for nutrition support
• Patients receiving artificial nutrition support
• Does not wish to have their qualitative interview audio-recorded (Group 2)

Participants with visual or hearing impairment or other physical disabilities will NOT be excluded from the study.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Patient group 2; Qualitative interview, key stakeholders, documentary analysis	Other: Interviews, key stakeholders, documents; Qualitative interviews, key stakeholders, documentary analysis
Patient group 1; Consultation observation, documentary analysis	Other: Observations, documents; Consultation observations, documentary analysis
Dietitians; Consulting Dietitians	Other: Interviews, key stakeholders, documents; Qualitative interviews, key stakeholders, documentary analysis; Other: Observations, documents; Consultation observations, documentary analysis
Key Stakeholders; Patient-Nominated Key Stakeholders (Relatives/Carers)	Other: Interviews, key stakeholders, documents; Qualitative interviews, key stakeholders, documentary analysis

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Experience of the Dietetic Consultation (Number of Participants With Dietetic Consultation Experience That Relate to Each Theme)	Themes and sub-themes related to the patient experience, dietitian experience and key stakeholder experience of the consultation. These were derived from qualitative thematic analysis of triangulated data from interviews, consultation observations and consultation documents derived from ALL study participants (n=39). Final themes included: 1. Building a therapeutic alliance 2. Navigating changes beyond the consultation 3. Dynamics of expectations, power and satisfaction 4. Influences and realities of professional practice. Please note that ALL study participants (n=39) from all 4 groups (Patient Group 1, Patient Group 2, Dietitians, and Key Stakeholders) contributed to all 4 final constructed themes noted above as all data were qualitatively triangulated. These 4 themes represent how the dietetic consultation was experienced from multiple perspectives, in different contexts and highlighted key areas of the dietetic encounter that mattered to participants.	Through study completion, an average of 2 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Dietitian AfC Banding	The NHS AfC Banding for consulting dietitians included. NHS Band 5 = entry level dietitian, NHS Band 6 = more experienced and specialised dietitian, NHS Band 7 = more advanced level dietitian. Data were collected on the NHS Banding (determined by their employer) for each dietitian included to understand how their experiences differed by seniority. Data collected for dietitians only.	At enrollment.
Dietitian Speciality	Clinical speciality of consulting dietitians included. Data collected for dietitians only.	At enrollment
Type of Intervention	Type of nutritional support intervention the patient received during dietetic consultation. Data collected for patients only.	At enrollment.
Consultation Type	New (i.e. new episode of dietetic care) or review/follow-up (had previous consultation in current episode of care) re the dietetic consultation. Data collected for patients only.	At enrollment.
Family Support	Whether the patient had family support or not at the time of study enrollment. Data collected for patients only.	At enrollment.
Relationship to Patient	Relationship of key stakeholder to patient. Data collected for key stakeholders only.	At enrollment.

Collaborators and Investigators

• Sponsor: King's College London
• Investigators: Study Chair: Alastair Duncan, PhD, King's College London

Study record dates

Study Major Dates

• Study Start (Actual): March 16, 2018
• Primary Completion (Actual): December 12, 2019
• Study Completion (Actual): July 31, 2022

Study Registration Dates

• First Submitted: April 16, 2018
• First Submitted That Met QC Criteria: April 25, 2018
• First Posted (Actual): April 26, 2018

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 3, 2025
• Last Verified: December 1, 2024

More Information

Terms related to this study

• Keywords: older adults; patient experience; nutritional care; disease-related malnutrition; dietetic consultation; oral nutritional support
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: 184290

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No