Patients with head and neck cancer (HNC) can have elevated risk of experiencing difficulties in swallowing and malnutrition. To prevent this, enteral nutrition through feeding tube (TF) insertion is encouraged when undergoing chemotherapy and radiation therapy. Whilst TFs are a proactive measure, the unpredictability of nutrition-impacting symptom development and the absence of consistent guidelines for informed decision-making of TF insertion can result in unnecessary TF procedures and patient distress.
Driven to address this gap and to improve person-centered care, Evelyn Wu, Eleah Stringer, Nasime Sarbar and Terry Lok, registered dietitians; Samantha Gamble, speech language pathologist; Cheryl Stephens and David Youngson, patient partners, came together for the inaugural 2022 BC Cancer Knowledge Translation (KT) Challenge Program. To support decision-making processes in their clinical practice, the team implemented an evidence-based discussion aid (DA) for enteral nutrition at BC Cancer - Abbotsford. This tool would complement conversations between clinicians and patients and empower patients to make informed decisions about TFs based on their personal beliefs and values.
From left to right: Eleah Stringer, Samantha Gamble, Terry Lok, Evelyn Wu and Nick Bansback
When asked about the importance of Knowledge Translation:
Evelyn Wu, team lead said, “KT is essential for getting research or knowledge to the clinician and patient in a practical way that enhances the care that is provided to patients. I love that [BC Cancer's] KT Challenge is a collaboration between clinicians who want to pass on important knowledge and patient partners who tell us what they want to know and how to best dispense this information, along with expert advice from mentors who know subject matter."
“I see KT as the action behind intention. Research and quality improvement are in place to improve a process, practice, etc., but KT is what actually brings this intention to life," says Eleah Stringer. “KT taps into valuable knowledge, stories, and experiences to produce something valuable."
Integrating evidence into practice through implementation and evaluation
The DA was piloted to 50 patients with HNC at BC Cancer - Abbotsford after several iterations to ensure language was appropriate, safe and trauma informed. Evaluation metrics showed overwhelmingly positive feedback on the DA's acceptance and usefulness, with patients finding it effective when making informed decisions. The DA's written and visual format also proved to be an inclusive way to deliver health information for different learning styles.
The DA was also introduced to the BC Cancer - Abbotsford's interdisciplinary Head and Neck Tumor Group, including registered dietitians, nurses, and speech language pathologists. The group's tremendous interest in the DA and acknowledgment of its effectiveness in improving person-centered care spoke to the longstanding need for this tool in practice. The DA has become a fundamental aspect of patient assessments, both during initial consultation and follow up, especially for patients beginning to experience side effects or those considered at risk of malnutrition.
“The highlight of the KT Challenge for me was getting to work with people who I wouldn't have had the opportunity to work with otherwise," says Eleah. “Our team represents clinicians from three different regional BC Cancer centres who had never worked on any project together. So it was so wonderful getting to truly know each of them. The same can be said for our patient partners - I never would have met our two wonderful patient partners if it weren't for this project that brought us all together under the shared purpose of producing a resource to help future patients."
From left to right: Evelyn Wu, Eleah Stringer and Nasime Sarbar
Patient voices & clinical collaboration to move evidence into practice
The collaborative approach with allied health clinicians and patient partners was a stand-out reflection throughout the project. Centering the perspectives of patient partners as active team members to develop the DA was critical to its success, ensuring it was reflective and relevant of the living experience with HNC. Engagement with multidisciplinary clinicians who work closely with HNC patients ensured project goals were aligned with the need and shared vision to improve current clinical practice in enteral nutrition.
The finalized DA is the first written resource that supports a patients' decision on TFs and was shared with dietitians across BC Cancer on June 4, 2024. The 'Tube Feeding Information for Head and Neck Cancer Patients' document will soon be published to the BC Cancer website and available to use here.
This represents an innovative step forward in advancing person-centered care through collaborative patient and provider decision-making. When asked about advice for point-of-care clinicians wanting to learn more about KT or about joining the KT Challenge, Evelyn shared:
“The KT journey is long and involves many steps but carrying out a project through the [KT Challenge] means you will have mentors that can advise as you navigate the project, a framework to help ensure successful completion of your project in a timely manner, and a budget to help fund the work that you would otherwise not get just trying to do it on the side of your desk."