Malnutrition contributes negatively to clinical outcomes, quality of life and overall cancer survival. A Model of Care (MOC), where nurses complete the validated Malnutrition Screening Tool (MST) with patients, has been implemented in the Peter MacCallum Cancer Centre (Peter Mac) chemotherapy day unit since 2011, however nursing compliance is declining. A significant increase in chemotherapy chair numbers, and therefore patients, meant it was timely that a formative-process evaluation was undertaken to ensure that the MOC and dietetic service is appropriate and effective at identifying and treating malnutrition risk.
RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) provided the overall framework for a mixed methods evaluation approach. A retrospective medical record audit was used (n= 148) to examine nutritional management practices. Three focus groups with day therapy nursing staff (n=12) recruited via convenience sampling explored experiences of using the MST and making referrals. Audio recordings were transcribed verbatim and thematic analysis conducted.
Suboptimal screening rates (57%) alongside associated skewed findings with the MST process suggest accuracy issues. Patients recognised as at risk of malnutrition had 96% of referrals actioned, 99% responsiveness in accordance to timeframe protocols, and 92% adherence to high-risk identification criteria. Five contextual barriers emerged from focus groups: utilisation, knowledge, skills and awareness, clinical judgement, competing priorities, and acknowledgement.
Key local contextual issues were found to exist with the screening process that has implications for the implementation of the Peter Mac MOC. These were reinforced by insights from the nursing experience which identified barriers directly impacting on utilisation of the MST and contributing to suboptimal screening rates. The recommendations devised, aim to work with nurses at the local level to create awareness; provide knowledge, skills and the ability to improve current practices to effectively screen all chemotherapy patients in line with best evidence-based practice.