- Title
- Eating As Treatment (EAT): psychological strategies to prevent malnutrition in head and neck cancer patients undergoing radiotherapy
- Creator
- Britton, Benjamin
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2018
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Cancers of the nose, mouth and throat linings and their connected tissues are collectively known as Head and Neck Cancer (HNC). HNC is common and has relatively poor survival rates. Due to its association with alcohol and tobacco use, HNC occurs in a population with unique challenges distinct from other cancer groups. HNC patients are more likely to be males, of lower SES, and have a diagnosable mental illness. These challenges are compounded once patients begin treatment as the side effects of the radiotherapy in addition to the tumour itself begins to inhibit adequate intake of nutrition. It is estimated that up to 88% of HNC patients are malnourished during cancer treatment. Malnutrition is associated with poorer morbidity and mortality outcomes. Malnourished HNC patients can be successfully treated by oncology dietitians that have evidence-based interventions at their disposal, however these are only effective if the patient actually adheres to the dietetic protocol. Seen in this context it becomes clear that for dietetic interventions for HNC to be effective, they require significant behaviour change from the patient. Until now there have been no randomised trials of behavioural interventions to improve nutrition in HNC patients, despite evidence from other clinical populations in which psychological intervention has demonstrably improved patient nutrition. To address this gap, this thesis aimed to develop, refine and evaluate the effectiveness of a psychological intervention, to improve nutritional status in HNC patients undergoing radiotherapy. Specifically, the thesis aims were to: 1. Systematically review the acceptability and feasibility of psychological interventions that have been already used with HNC patients ; 2. Pilot test a behavioural intervention, delivered by a clinical psychologist, evaluating its efficacy to improve nutrition in HNC patients undergoing radiotherapy in a NSW radiation oncology department ; 3. Examine via a pre-post comparison of consultation room recordings, whether oncology dietitians could be trained in a refined version of the behavioural interventions Eating As Treatment (EAT) and measure the consequent changes in their routine clinical behaviour ; 4. Assess the effectiveness of the behavioural intervention EAT in improving nutrition in HNC patients on a larger scale, delivered by dietitians in Australian radiation oncology departments via a multi- centre stepped wedge randomised controlled trial ; 5. Evaluate dietitians’ fidelity to the intervention protocol by comparing blinded ratings of intervention and control condition audio recordings. The papers contained within demonstrate that psychological interventions for HNC patients are acceptable and feasible; that psychological interventions can improve HNC patients’ nutrition; that dietitians can be successfully trained in a refined version of the intervention; and that this delivery can significantly improve nutrition for HNC patients in Australian radiation oncology departments. Implications for clinical practice, implementation and future research are then discussed.
- Subject
- head and neck cancer; malnutrition; psycho-oncology; behaviour change; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1393794
- Identifier
- uon:33612
- Rights
- Copyright 2018 Benjamin Britton
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 19 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 363 KB | Adobe Acrobat PDF | View Details Download |