Cancer patients are at high risk of undernutrition which contributes to poor prognosis( Reference Singer 1 ). Providing prompt and effective nutritional care to cancer patients is important to improve their quality of life and increase survival. However, cancer patients report that they receive little support on nutrition management from health care professionals (HCP)( Reference Locher, Robinson and Bailey 2 ). During a needs assessment in Ayrshire & Arran, staff expressed a need to improve knowledge and skills about nutritional care of cancer patients( Reference Provan and McCreaddie 3 ). NHS Ayrshire & Arran and Macmillan have developed and launched an e-learning programme “Nutritional care of people affected by cancer”( 4 ). We conducted an external evaluation of the programme using qualitative and quantitative methods to determine the programme effectiveness by measuring participants' knowledge, attitudes, and confidence in nutritional care in cancer.
Focus groups and structured telephone interviews with NHS staff in Ayrshire aided questionnaire development. The final questionnaires were linked to the online programme( 4 ) and tested knowledge using case studies, assessed practice, attitudes and confidence, and evaluated the content, delivery and impact of the programme. Data was collected at baseline, after module completion (data not shown) and at 6 months follow-up.
After 11 months, a total of 1125 participants had enrolled and 118 users (10%) had completed the entire programme. Baseline questionnaires were completed by 31% (n=338) of those enrolled and 6 months follow-up questionnaires by 21% (n=31) of those who completed the course (19% response rate). Most participants were dieticians (25% at baseline and 40% at follow-up) and nurses (17% at baseline and 27% at follow-up). At baseline>80% dieticians provided tailored nutritional plans, nutrition advice, food supplements and recommended to patients “to eat what they can” while>70% nurses referred to a dietician and provided diet advice. Screening for malnutrition was common amongst dieticians and nurses but not other HCP. Baseline nutritional knowledge was very good but only 22% of participants had correct knowledge about screening for malnutrition using a screening tool like MUST( 5 ). Participants felt nutrition was important for cancer treatment and most (59% to 74%) felt confident in their knowledge about weight loss, nutritional screening, supplement feeds/sip feeds, treatment of side effects using non pharmacological agents, health literacy and effective provision of information. Participants, however, were not confident about knowledge on malnutrition treatment (44%), alternative/fad diets (67%) and advice on adequate sources of internet based information (50%). Attitudes towards provision of information were mostly positive.
At 6 months follow-up, 88% agreed that the course fulfilled their expectations. The total course rating was good (mode 5, 1–7 scale). The majority of participants rated the course organisation/structure (stories, navigation, external links, assessment) as good whereas the content was rated as very good/excellent. Nearly half the participants said they had changed their practice such as they now refer to support groups and less were advising patients “to eat what they can” or providing standard nutrition information leaflets. An increase in confidence about their knowledge on complementary and therapeutic diets (58%) and on fad diets (55%) was reported. However, knowledge about nutritional screening was not retained by most participants.
Overall the education programme has been well received but completion rates are low. The course helped participants to re-enforce knowledge, attitudes and confidence but long term knowledge in areas such as nutritional screening needs further attention.
