title: Identifying the Barriers and Enablers to Nutrition Care in Head and Neck and Esophageal Cancers: An International Qualitative Study.
abstract: BACKGROUND
  The goal of this work was to identify barriers and enablers to the implementation of nutrition care in head and neck and esophageal (HNE) cancers and to prioritize barriers to help improve the nutrition care process.
  
  
  METHODS
  This study used a multimethod qualitative study design (including semistructured interviews, focus group). Interviews (n = 29) were conducted at 5 European sites providing care and treatment to patients with HNE cancers. A focus group (n = 21) reviewed and corroborated interview findings and identified priorities for nutrition care. Participants were healthcare providers and researchers with direct experience in the field of HNE cancer.
  
  
  RESULTS
  Five themes with accompanying barriers and enablers were identified related to nutrition care: (1) evidence for the benefit of nutrition interventions, (2) implementation of nutrition care processes (assessment, intervention, and follow-up), (3) characteristics of healthcare providers, (4) site factors, and (5) patient characteristics. Focus group discussions identified 2 priorities that must be acted on to improve nutrition care: (1) improve the evidence base and (2) develop standardized nutrition care pathways.
  
  
  CONCLUSIONS
  Themes related to nutrition care in HNE cancers were similar between sites, but barriers and enablers differed. Interview and focus group participants agreed the following actions will result in improvements in nutrition care: (1) enhance the evidence base to test the benefit of nutrition interventions, with a focus on resolving specific controversies regarding nutrition therapy, and (2) establish a minimum data set with a goal to create standardized nutrition care pathways where roles and responsibilities for care are clearly defined.
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Martin
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, the Netherlands Department of Nutrition, Sports and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands.
authors.forename: Marian A E
authors.initials: MA
authors.lastname: de van der Schueren
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Susanne
authors.initials: S
authors.lastname: Blauwhoff-Buskermolen
authors.affiliation: Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Vickie
authors.initials: V
authors.lastname: Baracos
authors.affiliation: Department of Nutrition and Dietetics, Internal Medicine VU University Medical Center, Amsterdam, the Netherlands Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Royal Alexandra Hospital, Alberta Health Services, Edmonton, Alberta, Canada leah.gramlich@ualberta.ca.
authors.forename: Leah
authors.initials: L
authors.lastname: Gramlich
mesh_terms: D004938:Esophageal Neoplasms / Q000178:diet therapy*; D005060:Europe; D019317:Evidence-Based Medicine; D017144:Focus Groups; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D015596:Nutrition Assessment; D044623:Nutrition Therapy; D018529:Nutritional Support; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D058996:Quality Improvement; D011795:Surveys and Questionnaires
keywords: barriers, enablers; cancer; esophagus; head and neck; nutrition