How to ensure success in caring for our patients-clients?

Published on September 29, 2023

As professionals, we share a common responsibility towards the health and well-being of our patients-clients. However, despite our dedication, there are barriers and obstacles to interprofessional collaboration, sometimes limiting our ability to provide optimal support in achieving results with our patients-clients..

The barriers

A common barrier to interprofessional collaboration is the difficulty in discussing sensitive subjects such as weight with our patients-clients. Some of us may feel uncomfortable addressing weight loss, preferring to use gentler terms to encourage dietary changes. Moreover, it's possible that some do not fully perceive the usefulness of a nutritionist referral. After all, we all have basic knowledge of nutrition and all eat three times a day! It may seem common sense to think that our patients-clients understand what changes they need to make to their diet to improve their health.

What do we stand to gain from collaborating? 

Unfortunately, the assumption that our patients-clients have basic knowledge of nutrition is false. Health literacy among the majority of the population is often lacking, as highlighted by the Enquête sur la littératie et les compétences des adultes (International Adult Literacy and Skills Survey), where nearly 60% of the Canadian population reportedly has low health literacy (1). Consequently, the recommendations we provide may not be fully understood and implemented by our patients-client, potentially leading to overly severe dietary restrictions, inadequate changes that could worsen their health, or anxiety about food. This is where the role of nutritionists becomes crucial: assisting the patient-client in targeting the right changes and personalizing their diet for their lifestyle and goals is our daily work.

Similarly, scientific data underscore the importance of long-term guidance for dietary changes to ensure adherence and lasting results (2). A literature review, reporting the maintenance of dietary changes beyond 12 months, outlines that sustained changes over 4 years rely on intensive interventions at regular intervals, including 19 nutrition consultations (2).

Here are some examples of the potential impact of nutrition on the health of your patients-clients:

• Osteoarthritis: a 1-pound loss reduces joint pressure by 4 pounds (3). Similarly, a 10% loss of initial weight leads to a 28% improvement in functionality (4).
• Depression: a meta-analysis concludes that nutritional treatment significantly reduces depressive symptoms (p=0.002) (5). A recent literature review highlights the importance of the intestinal microbiota in depression, which can be greatly influenced by diet (6).
• Cholesterol: according to a meta-analysis, the Portfolio Diet combined with NCEP II recommendations results in a 17% reduction in LDL-C, as well as numerous improvements in lipid profile, inflammation, blood pressure, and cardiovascular risk over 10 years (7).
• Diabetes: according to a meta-analysis, a low glycemic index diet is associated with a reduction in HbA1C (GRADE score: high), blood glucose, weight, and inflammation, as well as an improvement in lipid profile (8).

These examples highlight the importance of collaborating for optimal improvement in the health of our patients-clients.

How to engage the patient-client

To overcome the challenges, there are practical approaches we can adopt:

• Respect each other's expertise: Initiate the conversation about nutrition by acknowledging the specific skills of each professional and then referring to the appropriate specialist. Example: You have removed several foods from your diet to better control your cholesterol. Have you ever considered consulting a nutritionist to help you identify the right dietary changes and provide long-term support? What do you think of this option?
• Seize opportunities: Identify opportune moments to address nutritional topics. Contextual discussion can naturally open the door to these conversations. Example: You're looking for ways to improve your digestive symptoms. Identifying the foods that worsen your symptoms and having a diet tailored to your digestive issues could greatly help your intestinal function. What do you think?
• The art of motivational interviewing: Acknowledge that results are not instant. Engage in subtle and gentle conversations to plant seeds of change. Example: You're exhausted from your pain. Did you know that losing one pound can reduce the pressure on your joints by 4 pounds? What do you think of this information?
• Don't wait for patient preparedness: You don't have to wait until the patient is completely ready to address nutrition-related questions. Begin the conversation openly and engagingly. Example: You're having difficulty managing your diabetes. Can you think of any actions you could take to help yourself? Have you ever considered consulting a nutritionist?

In summary, interprofessional collaboration is an essential component of the well-being of our patients-clients. The dietitian-nutritionists at TeamNutrition are invaluable resources to help clients achieve their health goals. Feel free to invite your patients-clients to contact us: an advisor will be happy to answer their questions. Don't hesitate to do it yourself if you'd like to learn more about our services.

References: 

1. Conseil Canadien sur l’apprentissage (2008, Février). Littératie en santé au Canada: une question de bien-être. http://bv.cdeacf.ca/RA_PDF/42954.pdf 
2. Chapman, K. (2010). Can people make healthy changes to their diet and maintain them in the long term? A review of the evidence. Appetite, 54(3), 433–441. https://doi.org/10.1016/j.appet.2010.01.017   
3. Atukorala & al. Is there a dose-response relationship between weight loss and symtom improvment in person with knee OA? Arthitis Care Res (hoboken) 2016;68:1106-14.
4. Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage 2005; 13: 20–27.
5. Firth J, Marx W, Dash S, Carney R, Teasdale SB, Solmi M, et al. The effects of dietary improvement on symptoms of depression and anxiety: a meta-analysis of randomized controlled trials. Psychosom Med. (2019) 81:265–80. doi: 10.1097/PSY.0000000000000673 123.  
6. Ghannoum, M. A., Ford, M., Bonomo, R. A., Gamal, A., & McCormick, T. S. (2021). A Microbiome-Driven Approach to Combating Depression During the COVID-19 Pandemic. Frontiers in nutrition, 8, 672390. https://doi.org/10.3389/fnut.2021.672390 
7. Chiavaroli, L., Nishi, S. K., Khan, T. A., Braunstein, C. R., Glenn, A. J., Mejia, S. B., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Jenkins, D. J. A., Kendall, C. W. C., & Sievenpiper, J. L. (2018). Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials. Progress in cardiovascular diseases, 61(1), 43–53. https://doi.org/10.1016/j.pcad.2018.05.004 
8. Chiavaroli, L., Lee, D., Ahmed, A., Cheung, A., Khan, T. A., Blanco, S., Mejia, Mirrahimi, A., Jenkins, D. J. A., Livesey, G., Wolever, T. M. S., Rahelić, D., Kahleová, H., Salas-Salvadó, J., Kendall, C. W. C., & Sievenpiper, J. L. (2021). Effect of low glycaemic index or load dietary patterns on glycaemic control and cardiometabolic risk factors in diabetes: systematic review and meta-analysis of randomised controlled trials. BMJ (Clinical research ed.), 374, n1651. https://doi.org/10.1136/bmj.n1651