Implementation strategies for integrating nutritional interventions into cancer care: A systematic literature review

Abstract

Background and Aim: Nutritional conditions and malnutrition commonly affect people diagnosed with cancer, leading to worse outcomes and reduced quality of life. An implementation science approach may improve the delivery of evidence-based nutrition in cancer. The aim of this review is to systematically evaluate published literature for implementation strategies that have been applied to improve delivery of nutritional interventions in cancer. Methods: A literature search of databases including MEDLINE, EMBASE, Global Health, APA PsychINFO, CINAHL, yielded 5164 articles, of which 37 were included, comprising 30 independent studies. Reported barriers were classified according to the updated Consolidated Framework for Implementation Research (CFIR 2.0). Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC). The CFIR-ERIC Implementation Matching Tool was used to evaluate the extent to which current implementation strategies align with existing evidence, and to identify future strategies. Results: Lack of knowledge and awareness of nutritional guidelines among clinicians and available resources were the most frequently reported barriers. The implementation strategies “Audit and provide feedback” and “Conduct educational meetings” were the most widely used. Adoption and fidelity were the most frequently assessed (27/30, 90 % of studies) implementation outcomes, with 22 (81.5 %) studies reporting positive findings. Four out of five (80.0 %) studies measuring patient satisfaction reported improvements with implementation strategies. Conclusion: Deficits in knowledge and available resources are key barriers to implementation of nutritional interventions in cancer. The use of implementation strategies is associated with improved implementation, service, and patient-level outcomes. Key strategies to effective implementation include education, audit and feedback, and assessment of barriers and facilitators. Registry and registry number for systematic reviews and meta-analyses: This review protocol is registered with the PROSPERO group (CRD42023454210).