Chronic intestinal failure knowledge among a cohort of ASPEN registered dietitians: Response to a membership survey

Rare and nutritionally complex diseases, like chronic intestinal failure (CIF), are not encountered regularly by clinicians. Specialized centers with experience in intestinal failure are relatively sparse, leading many patients to rely on local clinicians. Previously published reports demonstrated lack of knowledge in intestinal failure among gastroenterologists in the United States, in Europe, and in the United Kingdom. This study aims to evaluate intestinal failure knowledge in a cohort of registered dietitians.

A validated, 20-question survey on CIF knowledge covering four key domains was sent to dietitian members of the American Society for Parenteral and Enteral Nutrition. Descriptive data were collected regarding respondents' clinical practice characteristics. Performance was evaluated, and results were compared between self-identified experts and nonexperts in CIF and parenteral nutrition.

Of 94 respondents, 34% self-identified as experts in intestinal failure and 53% in parenteral nutrition management. Most self-identified intestinal failure experts (81.3%) reported managing 11-20 patients with CIF annually, but less than half worked with a multidisciplinary team, and less than one-quarter practiced in an intestinal rehabilitation program. Overall median score was 13.0 (IQR 11.0-15.0). Self-identified dietitians reporting expertise in intestinal failure and parenteral nutrition scored 15 (IQR 12-17) and 14 (IQR 12-17), respectively.

Regardless of self-reported level of expertise, dietitian knowledge scores were high for home parenteral nutrition monitoring and complications of CIF. Given the integral role nutrition plays in intestinal failure, dietitians should be involved in the management of patients with CIF.