As health care professionals interested in clinical nutrition, we face numerous challenges as we try and provide optimal nutrition to individual patients in our health care system. Some of the difficulties in achieving optimal nutritional policies and practices arise from the devaluation or de-prioritization of nutrition issues relative to other clinical problems our patients face. As a consequence, malnutrition continues to go unassessed, significant underfeeding continues in institutionalized care, and patients experience the attendant negative consequences of poor or inadequate nutritional management. I posit that a large part of the problem can be attributed to a weak or absent evidentiary basis that informs our clinical practice guidelines. Evidence for this assertion comes from a review of recent clinical practice guidelines and the nature of the evidence informing these guidelines that reveals few strong clinical recommendations and numerous small, low-moderate quality single center randomized trials. Moreover, existing large-scale RCTs study selected patients and have limited applicability to the broader practice setting. What can be done to rectify this situation and ultimately improve patient outcomes? I will offer 4 potential solutions that will elevate the practice of clinical nutrition and make it easier to get our job accomplished and aid our patients in achieving the best possible outcomes: 1) the creation of registry-based, volunteer supported, large-scale, clinical trials; 2) the creation of research networks and protocol development meetings; 3) a shift away from physiological measurements and mortality to more rigorous patient centered outcomes including activity and performance-based measures; and 4) family engagement and capacitation in nutrition care of their loved ones. Collectively, these efforts have the possibility to transform the nature of the evidence underpinning our nutrition recommendations and how nutrition is valued by our peers, patients, and their families.
List some barriers and facilitators to achieving best clinical nutrition practice
Describe the process by which we as a clinical nutrition community can collaborate to generate high levels of evidence to support our nutrition practice
Summarize the role of family capacitation and engagement in improving nutrition practice
Director, Clinical Evaluation Research Unit, Kingston General Hospital; Director, The Canadian Researchers at the End of Life Network; Director, Critical Care Nutrition,
Queen's University, Kingston, Ontario, Canada