title: Teaching nutrition integration: MUST screening in cancer.
abstract: BACKGROUND
  Nutritional risk screening should be routine in order to select patients in need of nutrition care; this conduct change has to rely on education. In this project, radiotherapy department health professionals were trained on how to use the Malnutrition Universal Screening Tool (MUST), to foster its integration into cancer outpatient management; we also aimed to identify those more adherent to screening.
  
  
  METHODS
  Research dieticians (the standard) conducted interactive sessions with all physicians, nurses, and radiotherapy (RT) technicians, who were closely supervised to facilitate routine MUST integration. There were two phases: after the first session, phase 1 assessed 200 patients over 4 months; after the second session, phase 2 screened 450 patients, always before RT. Validity was evaluated comparing results from the standard against all other health professionals, adjusted for number.
  
  
  RESULTS
  RT technicians were most adherent to the MUST: 80% of patients in phase 1, increasing to 85% in phase 2. Nurses doubled their input, from 19% to 36%. Physicians had poor MUST integration, yet they progressively incorporated percentage weight loss into patient records, increasing from 57% in phase 1 to 84% in phase 2, independently of diagnosis and stage. The highest concordance (κ coefficient) with dieticians was found with RT technicians' use of the MUST (p < .002) and percentage weight loss determination by physicians (p < .001).
  
  
  CONCLUSIONS
  We show that systematic screening in cancer is feasible by all professionals involved, once a proximity teaching project is put into practice. RT technicians, who daily treat patients, were highly adherent to integrate the MUST and might be in charge of selecting at-risk patients. Physicians are unlikely to use the MUST, but acknowledged nutrition value and changed their routine by integrating recent percentage weight loss into their approach to patients. Our structured methodology may be used as a model for the development of teaching adapted to different departments with other realities.
authors.affiliation: Unidade de Nutriçào e Metabolismo, Faculdade de Medicina de Lisboa, Instituto de Medicina Molecular, 1649-028 Lisboa, Portugal.
authors.forename: Carolina
authors.initials: C
authors.lastname: Boléo-Tomé
authors.forename: Mariana
authors.initials: M
authors.lastname: Chaves
authors.forename: Isabel
authors.initials: I
authors.lastname: Monteiro-Grillo
authors.forename: Maria
authors.initials: M
authors.lastname: Camilo
authors.forename: Paula
authors.initials: P
authors.lastname: Ravasco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D004517:Education, Professional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D017145:Models, Educational; D009369:Neoplasms / Q000150:complications*; D015596:Nutrition Assessment; D044623:Nutrition Therapy; D052756:Nutritional Sciences / Q000193:education / Q000639:trends; D009752:Nutritional Status; D010361:Patients; D011380:Programmed Instructions as Topic; D012073:Remedial Teaching / Q000379:methods*; D015203:Reproducibility of Results; D012307:Risk Factors