Implementation of Digital Seamless Nutrition Care throughout the Treatment Course for Patients with Head and Neck...

Nutritional interventions may reduce the prevalence of malnutrition in patients with head and neck cancer; however, implementation often fails due to barriers at various levels. Process evaluations can provide an understanding of implementation outcomes, mechanisms of impact, and context and provide information about feasibility and acceptability.

To perform a process evaluation of the Nutrition Throughout the Treatment Course (NUTREAT) intervention, including use of the MyFood app and web report. Specifically, we aimed to evaluate 1) the acceptability, adoption, appropriateness, feasibility, and fidelity of the intervention, 2) the implementation plan, and 3) patient adherence to the intervention.

A mixed methods approach was applied, including individual interviews, a focus group discussion, log data from electronic patient records (EPRs), an experience questionnaire, and information from the MyFood web report. Proctor's implementation outcomes guided the development of the interview guide and analysis. Themes were deductively established using codebook thematic analysis. The implementation plan was evaluated through logs of completed activities. Log data from EPRs were collected to evaluate fidelity among healthcare professionals (HCPs), and information from the MyFood web report informed patient adherence to the intervention.

Individual interviews were conducted with patients (n = 8), registered nurses (n = 3), and leaders (n = 2), and a focus group discussion was conducted with registered dietitians (n = 6). Patients, registered nurses, registered dietitians, and leaders found the intervention acceptable, appropriate, and feasible. Patient adherence was high, whereas fidelity among HCPs was low.

The NUTREAT intervention increased patients' awareness of their own nutritional requirements and was considered helpful by HCPs in preparing for patient consultations. However, fidelity among HCPs was low. Future efforts should focus on identifying strategies to improve fidelity among HCPs and study the long-term sustainability of the intervention.This study was registered at clinicaltrials.gov as NCT05997329.