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Introduction: The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. Aim: To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. Methods: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. Results: The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). Conclusion: The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty

Introduction: The scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated tool for the screening, assessment and monitoring of malnutrition, and triaging of interventions. It contains a patient-generated component and a healthcare professional (HCP)-generated component. Aim: To translate the PG-SGA into Swedish, assess the linguistic and content validity of the Swedish version, and ensure conceptional, semantic and operational equivalence to the original English PG-SGA. Methods: In line with the methodology used in previously translated and culturally adapted versions, the standardised 10-step process suggested by the International Society for Health Economics and Outcomes Research (ISPOR) was followed. In step 7, a cross-sectional study targeting patients n = 51 and HCPs n = 52 was performed at a university hospital in Sweden. Using separate questionnaires, patients assessed the patient component and HCPs, the professional component regarding perceived comprehensibility and difficulty (linguistic validity). The HCPs also assessed perceived relevance (content validity) of all items on the PG-SGA. Item indices for comprehensibility (I-CI), difficulty (I-DI) and content validity (I-CVI) were calculated and averaged into scale indices (S-CI, S-DI and S-CVI). Cut-off standards for item and scale indices were used as reference. Results: The Swedish version of the PG-SGA rated excellent for comprehensibility (S-CI 0.96) and difficulty (S-DI 0.93) for the patient component. The professional component rated acceptable for comprehensibility (S-CI 0.89) and below acceptable for difficulty (S-DI 0.70), with the physical examination rated most difficult (I-DI 0.39 to 0.69). Content validity for the full Swedish PG-SGA was rated excellent (S-CVI 0.94). Conclusion: The patient component was considered clear and easy to complete. The full Swedish PG-SGA was considered relevant by HCPs for screening and assessment of malnutrition. Due to perceived difficulty

Background: Successful implementation of the Nutrition Care Process (NCP) and the Nutrition Care Process Terminology (NCPT) depends on many factors, one of which is the spoken language of the users. Exploring implementation barriers and enablers in a multilingual country such as Switzerland, with a specific focus on dietitians speaking German and French, may provide valuable insights for successful implementation in other multilingual countries. Objective: The aim of this study was to compare the enablers and barriers encountered by Swiss German-and French-speaking dietitians in the implementation of NCP and NCPT in their daily work. Design: The multinational observational INIS study was conducted between February April 2017 using an online survey. Swiss data from the study were analyzed in a secondary analysis in August 2021. Participants: In Switzerland, 237 registered dietitians participated in the INIS study. In this secondary analysis, a total of 228 (German-speaking n = 144, French-speaking n = 84) questionnaires were included. Nine participants were excluded because either they had incomplete surveys or had not completed dietetics training. Main outcome measurements: Primary variables were barriers and enablers to the use of NCP and NCPT in their daily work. Furthermore, characteristics, familiarity with NCP and NCPT, and the extent of implementation of standardized nutrition diagnoses according to NCPT were analyzed. Statistical analyses performed: Descriptive statistics, including summary statistics with percentages, were used. Differences between the two groups were analyzed using the Fisher exact test. Results: The most common barrier was lack of time; no significant differences were found between the two groups regarding implementation barriers. Some statistically significant differences were found in the frequency of mentioning enablers, such as "recommendation by the association to use NCP and NCPT" (German-speaking 89%, French-speaking 77%; P < 0.0

To explore the inter-rater reliability of the Swedish translation of NCP-QUEST in a Swedish context and investigate the level of agreement between Diet-NCP-Audit and NCP-QUEST in assessment of documentation quality. A retrospective audit was conducted of 40 electronic patient records written by dietitians at one University Hospital in Sweden. NCP-QUEST showed good inter-rater reliability for the quality category (ICC = 0.85) and excellent inter-rater reliability for total score (ICC = 0.97).

Background The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. Aims To explore the associations between clinical dietitians' self-reported documentation of patients' goals and outcomes and demographic factors, self-reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. Methods Data from a cross-sectional study based on a previously tested web-based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e-mail lists, e-newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi-square test. Associations between dependent- and independent variables were measured through logistic regression analysis. Results Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. Conclusion Findings highlight strong associations between the imple

To explore the inter-rater reliability of the Swedish translation of NCP-QUEST in a Swedish context and investigate the level of agreement between Diet-NCP-Audit and NCP-QUEST in assessment of documentation quality. A retrospective audit was conducted of 40 electronic patient records written by dietitians at one University Hospital in Sweden. NCP-QUEST showed good inter-rater reliability for the quality category (ICC = 0.85) and excellent inter-rater reliability for total score (ICC = 0.97).

To explore the inter-rater reliability of the Swedish translation of NCP-QUEST in a Swedish context and investigate the level of agreement between Diet-NCP-Audit and NCP-QUEST in assessment of documentation quality. A retrospective audit was conducted of 40 electronic patient records written by dietitians at one University Hospital in Sweden. NCP-QUEST showed good inter-rater reliability for the quality category (ICC = 0.85) and excellent inter-rater reliability for total score (ICC = 0.97).

Background The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. Aims To explore the associations between clinical dietitians' self-reported documentation of patients' goals and outcomes and demographic factors, self-reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. Methods Data from a cross-sectional study based on a previously tested web-based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e-mail lists, e-newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi-square test. Associations between dependent- and independent variables were measured through logistic regression analysis. Results Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. Conclusion Findings highlight strong associations between the imple

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals. Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

Background: The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. Methods: The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. Results: Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p < 0.001). Country of residence and working in clinical settings (p < 0.001) were demographic characteristics that were independent predictors of high knowledge and frequent use of NCP/T. A high knowledge score was an independent predictor of frequent NCP/T use (p = 0.002). Conclusions: Important modifiable enablers for NCP knowledge and use rely on organisational management. National dietetic organisations and key stakeholders such as employers are encouraged to integrate active NCP/T support in their leadership initiatives. This could take the form of policies, formalised and structured training strategies, and informatics initiatives for the integration in electronic health records.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals. Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals. Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals. Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

Objective: Setting goals collaboratively with patients is a key aspect in shared decision-making (SDM) in malnutrition interventions. The aim, therefore, was to gain an understanding of clinical dietitians' reflections regarding the process of goal-setting with patients at risk of malnutrition. Methods: Six semi-structured audio-recorded focus group discussions were held with registered dietitians (n = 29) from primary healthcare and hospitals in Sweden. Focus group transcripts were analysed thematically to find patterns in the data and identify themes. Results: Dietitians expressed striving to explore patients' narratives, capabilities, and resources before deciding on goals. They described different strategies in counseling patients and a lack of patient participation in the goal setting. They emphasized the difficulties of setting feasible goals due to discrepancies between their clinically oriented goals and patients' personal goals. Conclusion: Findings highlight a gap in the process of setting goals for patients at risk of malnutrition, where patients' participation was lacking. Education in SDM, and strategies and tools to support dietitians in involving patients in goal-setting, are required to bridge the gap and promote person-centeredness. Practice implications: Findings may be further used to develop tools and strategies, and design studies on the implementation of and education in SDM and goal-setting for malnutrition interventions.

BACKGROUND: Nutrition care plays a significant role in the prevention and treatment of malnutrition, although the challenge to establish the precise impact of a nutrition intervention on patient outcomes remains. Malnutrition can be associated with diverse underlying diseases and an increased risk of complications, which increases the difficulty of monitoring and evaluating the nutrition intervention. The aim is to gain an understanding of dietitians' reflections concerning nutrition care outcomes of interventions in patients at risk of malnutrition. METHODS: Six semi-structured audio-recorded focus group discussions with registered dietitians from primary healthcare and hospitals (n = 29) in Sweden were held at the dietitians' place of work or at the University. Focus group transcripts were analysed thematically to reveal patterns in the data and identify themes and subthemes. RESULTS: The dietitians described an approach to nutrition monitoring and evaluation of patients at risk of malnutrition that was categorised into three themes: (i) quantitative explicit outcomes, based on objective measures and described as rigorous; (ii) quantitative estimated outcomes, based on estimates and described as less rigorous and (iii) qualitative implicit outcomes, based on patients' subjective perceptions and experiences of their health and described as difficult to measure. CONCLUSIONS: Findings indicate the need for new strategies to promote systematic and comprehensive nutrition monitoring and evaluation.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.

This overview aims to create an understanding of the nutritional issues concerning patients with cancer and provide evidence-based practical guidance to healthcare professionals (physicians, nurses, and dietitians), caregivers, and all others involved in the care of patients with cancer. The focus of this paper is therefore on providing a simple guide for daily clinical practice. The theoretical background and in-depth comprehensive reviews of malnutrition are described elsewhere. Nutrition plays a crucial role in cancer care. It affects treatment tolerability, outcomes, and quality of life. However, a focus on nutrition is still lacking among oncologists because of insufficient training in nutrition topics received during graduate and postgraduate training and an underestimation of its importance. The consequences of the disease and its treatment, such as anorexia-sarcopenia-cachexia, are therefore still often overlooked, underdiagnosed, and undertreated. The authors have summarized the most important challenges, evidence-based recommendations, and common clinical scenarios to bridge the gap between comprehensive guidelines and clinical practice, where brief concrete advice is preferred to systematic reviews. Furthermore, an easy applicable overview is provided, which can be used as a guide during daily routines.

Background To explore the barriers and enablers experienced by nutrition and dietetic professionals in the implementation of the standardised Nutrition Care Process (NCP) across 10 different countries. NCP related beliefs, motivations and values were investigated and compared. Methods A validated online survey was disseminated to nutrition and dietetics professionals in 10 countries in the local language during 2017. Cross‐sectional associations and differences between countries were explored for level of implementation, barriers/enablers and attitudes/motivation among the respondents. Results Higher NCP implementation was associated with greater occurrence of enabling aspects, as well as fewer occurrences of barriers. The most common enabler was ‘recommendation by the national dietetic association’ (69%) and the most common barrier was ‘lack of time’ (39%). A longer experience of NCP use was associated with a more positive attitude towards all NCP aspects. Differences between countries were identified, regarding both the occurrence of barriers/enablers and attitudes/motivations. Conclusions Implementation efforts need to be tailored to country‐specific contexts when implementing a new standard of care framework among nutrition and dietetic professionals. Additional research is needed to further assess the management and workplace strategies to support the development of nutrition and dietetics professionals in multidisciplinary healthcare organisations.

Background: The Nutrition Care Process (NCP) and NCP Terminology (NCPT) is a systematic framework for critical thinking, decision making, and communication for dietetics practitioners worldwide, aiming to improve quality and patient safety in nutrition care. Although dietetics practitioners in several countries have implemented the NCP/NCPT during recent years, to date there is no globally validated instrument for the evaluation of NCP/NCPT implementation that is available in different languages and applicable across cultures and countries. Objective: The aim of this study was to develop and test a survey instrument in several languages to capture information at different stages of NCP/NCPT implementation across countries and cultures. Setting: In this collaboration between dietetics practitioners and researchers from 10 countries, an International NCP/NCPT Implementation Survey tool was developed and tested in a multistep process, building on the experiences from previous surveys. The tool was translated from English into six other languages. It includes four modules and describes demographic information, NCP/NCPT implementation, and related attitudes and knowledge. Methods: The survey was reviewed by 42 experts across 10 countries to assess content validity and clarity. After this, 30 dietetics practitioners participated in cognitive interviews while completing the survey. A pilot study was performed with 210 participants, of whom 40 completed the survey twice within a 2- to 3-week interval. Results: Scale content validity index average was 0.98 and question clarity index was 0.8 to 1.0. Cognitive interviews and comments from experts led to further clarifications of the survey. The repeated pilot test resulted in Krippendorff’s α=.75. Subsequently, refinements of the survey were made based on comments submitted by the pilot survey participants. Conclusions: The International NCP/NCPT Implementation Survey tool demonstrated excellent content validity and high test–

Background: Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. Objective: The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. Methods: A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. Main outcome measures and statistical analysis: The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. Results: Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. Conclusions: Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language to

Background The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently being implemented by nutrition and dietetics practitioners all over the world. Several advantages have been related to this implementation, such as consistency and clarity of dietetics-related health care records and the possibility to collect and research patient outcomes. However, little is known about dietitians’ experiences of the implementation process. Objective The aim of this qualitative study was to explore Swedish dietitians’ experiences of the NCP implementation process in different dietetics environments. Method Thirty-seven Swedish dietitians from 13 different dietetics workplaces participated in seven focus group discussions that were audiotaped and carefully transcribed. A thematic secondary analysis was performed, after which all the discussions were re-read, following the implementation narrative from each workplace. In the analysis, The Promoting Action on Research Implementation in Health Services implementation model was used as a framework. Results Main categories identified in the thematic analysis were leadership and implementation strategy, the group and colleagues, the electronic health record, and evaluation. Three typical cases are described to illustrate the diversity of these aspects in dietetics settings: Case A represents a small hospital with an inclusive leadership style and discussion-friendly culture where dietitians had embraced the NCP/NCPT implementation. Case B represents a larger hospital with a more hierarchical structure where dietitians were more ambivalent toward NCP/NCPT implementation. Case C represents the only dietitian working at a small multiprofessional primary care center who received no dietetics-related support from management or colleagues. She had not started NCP/NCPT implementation. Conclusions The diversity of dietetics settings and their different prerequisites should be considered in the development of NC

In this study, we explored Swedish dietitians’ experiences of a standardised Nutrition Care Process (NCP) and terminology from the perspective of Habermas’ concepts of system and lifeworld. Seven focus group discussions were analysed thematically. In thispaper, we argue that dietitians seem to mainly connect the NCP with a system perspective, highlighting aspects such as professionalism, measurability and clarity of the patient record as helpful outcomes from the NCP standardisation. We also see a tension between system and lifeworld, as dietitians emphasised the importance of the dietitian–patient relationship, stating that a patient’s complex situation does not always fit into the pre-defined NCP terms and measurements. Several approaches were identified whereby dietitians tried to reach a balance between the system and lifeworld. We argue that strategies for achieving this balance need more attention in the education and implementation of standardised care processes and terminologies.

Background & Aims Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent. However, the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. We aimed to determine whether dietitians in selected European countries have 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work. Methods An anonymous online survey was performed among dietitians in Belgium, the Netherlands, Norway and Sweden. 'Sufficient knowledge' was defined as having mentioned at least two of the three common domains of malnutrition according to ESPEN definition of malnutrition (2011): 'nutritional balance', 'body composition' and 'functionality and clinical outcome', and a correct answer to three cases on starvation, cachexia and sarcopenia. Chi-square test was used to analyse differences in experience, work place and number of malnourished patients treated between dietitians with 'sufficient knowledge' vs. 'less sufficient knowledge'. Results 712/7186 responded to the questionnaire, of which data of 369 dietitians were included in the analysis (5%). The term 'malnutrition' is being used in clinical practice by 88% of the respondents. Starvation, cachexia and sarcopenia is being used by 3%, 30% and 12% respectively. The cases on starvation, cachexia and sarcopenia were correctly identified by 58%, 43% and 74% respectively. 13% of the respondents had 'sufficient knowledge'. 31% of the respondents identified all cases correctly. The proportion of respondents with 'sufficient knowledge' was significantly higher in those working in a hospital or in municipality (16%, P<0.041), as compared to those working in other settings (7%). Conclusions The results of our survey among dietitians in four European countries show that the percentage of dietitians with 'sufficient

Aim High-quality documentation in patient records is essential for patient safety and plays a prominent role in the delivery and evaluation of dietetic/nutrition care. We aimed to evaluate dietitians' documentation in patient records according to the four steps in the Nutrition Care Process: assessment, diagnosis, intervention and monitoring/evaluation. Methods A retrospective audit of 147 systematically collected outpatient dietetic notes from primary care centres and hospitals in central Sweden was performed using a validated audit instrument. The instrument was used to assess the documentation of 14 items: 10 items focusing on the Nutrition Care Process steps and four items on language clarity and structure, with a maximum total score of 26 for each dietetic note. The notes were divided into three different quality levels, A (high score), B (medium score) or C (low score). Comparisons were made between notes from primary care and hospitals. Results The audit showed that the majority of the notes were placed at level B, scoring 13.5–19.5. Only 3% of the notes scored higher than 19.5. The most frequently documented items were intervention (90%), evaluation (70%) and nutrition problem (56%), whereas the least documented items were nutrition prescription (15%), goal of intervention (9%) and connection of problem-etiology-symptom (5%). Flaws in lingual clarity were common (72%). Primary care notes received higher scores than those from hospitals. Conclusions The audit shows that Swedish dietetic documentation needs to be improved, for example, by further training and education in the Nutrition Care Process and its standardised terminology.

Adequate documentation in medical records is important for high-quality health care. Documentation quality is widely studied within nursing, but studies are lacking within dietetic care. The aim of this study was to translate, elaborate and evaluate an audit instrument, based on the four-step Nutrition Care Process model, for documentation of dietetic care in medical records. The audit instrument includes 14 items focused on essential parts of dietetic care and the documentation's clarity and structure. Each item is to be rated 0-1 or 0-2 points, with a maximum total instrument score of 26. A detailed manual was added to facilitate the interpretation and increase the reliability of the instrument. The instrument is based on a similar tool initiated 9 years ago in the United States, which in this study was translated to Swedish and further elaborated. The translated and further elaborated instrument was named Diet-NCP-Audit. Firstly, the content validity of the Diet-NCP-Audit instrument was tested by five experienced dietitians. They rated the relevance and clarity of the included items. After a first rating, minor improvements were made. After the second rating, the Content Validity Indexes were 1.0, and the Clarity Index was 0.98. Secondly, to test the reliability, four dietitians reviewed 20 systematically collected dietetic notes independently using the audit instrument. Before the review, a calibration process was performed. A comparison of the reviews was performed, which resulted in a moderate inter-rater agreement with Krippendorff's α = 0.65-0.67. Grouping the audit results in three levels: lower, medium or higher range, a Krippendorff's α of 0.74 was considered high reliability. Also, an intra-rater reliability test-retest with a 9 weeks interval, performed by one dietitian, showed strong agreement. To conclude, the evaluated audit instrument had high content validity and moderate to high reliability and can be used in auditing documentation of dietetic car

An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the most documented part of dietetic care. However, the audit showed that several important parts of nutrition care were poorly documented, for instance nearly half of the audited records had no clear nutrition problem documented, and in most of the records, the goal of nutrition intervention was missing. The study shows that Swedish dietitians need to improve documentation in medical records, as a suggestion by implementing a more structured documentation model.

An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the most documented part of dietetic care. However, the audit showed that several important parts of nutrition care were poorly documented, for instance nearly half of the audited records had no clear nutrition problem documented, and in most of the records, the goal of nutrition intervention was missing. The study shows that Swedish dietitians need to improve documentation in medical records, as a suggestion by implementing a more structured documentation model.

An adequate documentation in medical records is essential for patient safety and high quality care. The aim of this study was to evaluate documentation by dietitians in Swedish medical records. A retrospective audit of 147 dietetic notes in electronic medical records was performed. The audit focused at documentation of essential parts of the dietetic care, as well as other quality aspects such as lingual clarity and structure of the documentation. The nutrition intervention showed to be the most documented part of dietetic care. However, the audit showed that several important parts of nutrition care were poorly documented, for instance nearly half of the audited records had no clear nutrition problem documented, and in most of the records, the goal of nutrition intervention was missing. The study shows that Swedish dietitians need to improve documentation in medical records, as a suggestion by implementing a more structured documentation model.