Failure to Thrive: A Qualitative Study of Registered Dietitian Nutritionists' Perspectives on Barriers to Timely Nutrition Support in Gastrointestinal Cancer.

BACKGROUND

Malnutrition affects about 61% of patients with gastrointestinal (GI) cancers, yet timely, registered dietitian nutritionist-led care is often delayed or uneven across settings.

OBJECTIVE

To identify registered dietitians' (RDs) perceived barriers to timely nutrition support in GI oncology within a multisite academic health system.

DESIGN

Qualitative descriptive study using semi-structured interviews, supplemented by a brief survey to characterize participants and practice context.

PARTICIPANTS/

SETTING

Seven RDs practicing across inpatient and outpatient services at a main campus and satellite sites (all non-Hispanic White women; median age 45 years, interquartile range [IQR] 37 to 52 years).

MAIN OUTCOME MEASURES: Perceived barriers to timely nutrition support; theme salience by clinician characteristics (years in practice, GI caseload, and number of facilities).

ANALYSES PERFORMED: Inductive thematic analysis by 2 coders with iterative codebook refinement and consensus; descriptive summaries of survey items; joint display mapping participant attributes to theme salience (0 = not mentioned, 1 = mentioned, 2 = strongly emphasized) and a salience-weighted score (the sum of the 5 theme ratings; range = 0 to 10).

RESULTS

Five barriers emerged: Access, Referral Timing, Coordination, Workforce Constraints, and Emotional Burden. Theme salience peaked among clinicians covering 2 or more facilities (mean salience-weighted score = 9.5 out of 10). In the joint display (years in practice, GI caseload, and the number of facilities), Access, Coordination, and Workforce appeared across all subgroups. All RDs endorsed a multidisciplinary team focused on nonmedical barriers.

CONCLUSIONS

System-level obstacles, particularly access limitations, coordination gaps, and staffing constraints, delay timely nutrition support in GI oncology, with multisite coverage intensifying these challenges. Findings highlight actionable leverage points for implementation, including standardized early referral triggers, structured cross-setting handoffs, streamlined resource navigation, and workforce supports. In response, a preoperative nutrition handout paired with an automatic RD referral at the surgical preoperative visit was initiated at the study institution. Prospective studies should assess the influence on nutritional status, treatment tolerance, and patient-reported outcomes.