Date of Award

Summer 8-24-2024

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Food Science

First Advisor

Simone Camel

Abstract

Oral nutritional supplements (ONS) are nutrient-dense beverages that aid in meeting the nutrient needs of patients. Recent research has indicated that patient adherence to prescribed nutritional supplements may depend on palatability, tolerance, and taste fatigue. Registered Dietitian Nutritionists (RDNs) are healthcare professionals who may prescribe these supplements directly or make recommendations to the patient’s physician for a prescription, thereby influencing patient adherence. Little research has been documented regarding taste fatigue and the influences of the RDN’s decisions on patient adherence to nutritional supplement adherence. The purpose of this study was to gain an understanding of the perspectives of nutrition professionals regarding oral supplement prescriptions, patient/client adherence issues, and taste fatigue. A convenience, purposive sample of adults over the age of 18 was recruited using network sampling. Those who were RDNs, Dietetic Technicians, and Food Service Employees were eligible to participate. An online questionnaire was developed and distributed using Qualtrics survey software. Eligible potential participants were first provided with a consent form and, if consented, were linked to a 29-question researcher-developed questionnaire. The questionnaire included characteristics of their workplace, ONS prescription processes, patient education regarding the ONS prescription, and the RDN perceptions of ONS taste fatigue and other issues impacting adherence. Data analysis was completed utilizing SPSS version 28.0. Findings included that approximately half of the participants’ report prescribing ONS as a daily supplement, the most common frequency being twice daily. Thirty-eight percent of the participants reported spending less than five minutes explaining the benefits and importance of ONS prescription adherence. Interestingly, the participants also reported that they considered this an adequate amount of time despite their experience with adherence. Increasing time spent with the patient could lead to identifying the root cause of the individual’s adherence barrier. In doing so, nutrition professionals could determine understanding of the supplement prescription as part of medical nutrition therapy, determine if the cost will be an issue and, if so, provide home-prepared recipes to limit cost, and thereby take steps to prevent taste fatigue while increasing prescription adherence. Facilities could create standard education materials highlighting the importance and benefits of complying with ONS prescriptions. The educational sheet should include the facility-specific ONS formulary for ease. The sheet could highlight the main components to look for e.g.- calories and protein. This procedure and/or policy in place could ensure nutritional professionals are spending an adequate amount of time with the patient/client educating them on the importance of ONS compliance. About half of the participants (50.8%) identified that their patients had a brand preference for ONS, and more than half of those preferred a different ONS brand than the one offered by their facility. Further exploring could reveal if there is a preferred brand by the majority of their patient population. If a particular brand is preferred, nutrition professionals could speak to their administration about formulary changes. If the brand preference is related to cost, nutritional professionals could potentially work with the patient’s care team to receive ONS insurance approval. Thirty-two percent of patients receive ONS during mealtimes and between mealtimes, and 19.7% receive ONS exclusively at mealtimes. Prescribing ONS during mealtimes could decrease the patient/client’s food intake during mealtimes. This procedure would be problematic because ONS are designed to meet the gap between a patient/client’s food intake and nutritional requirements. Nutritional professionals could work with food service employees to implement ONS delivery between mealtimes to help with ONS adherence and not interfere with the patient’s food intake. The study found that RDNs felt that 67.2% of the participants’ patients experienced taste fatigue. Taste-tasting various ONS brands could aid in selecting ONS for the patient. Nutrition professionals could provide patients with recipes and/or individual ingredients that could enhance the “base” flavor, such as a vanilla ONS. Enhancing the “base” flavor could allow the patient/client to experience many flavors to help with taste fatigue. Interestingly, 26.2% of nutritional professionals reported there were no formal discharge plans for prescribing ONS and only 11.5% of them sent a prescription prior to discharge. Formal discharge plans could also include the nutritional professional’s ONS prescription and the ONS educational handout in the discharge paperwork to reiterate the importance of this prescription. If insurance does not cover the ONS prescription, ONS coupons could also be included with the patient’s discharge paperwork to aid in cost. These could help with increasing ONS adherence which could decrease the presence of malnutrition. Fifteen percent of the participants reported they were unsure what their patient’s adherence barriers included. To understand their patients’ barriers, it would be beneficial and necessary for the nutritional professional to follow up with their patients/clients. This could potentially mean there is a gap in inpatient/outpatient care. This indicates that formal discharge planning is vital in patient care outcomes. A 15-minute follow-up a couple of weeks after the patient is discharged could aid the nutritional professional in further recommendations based on what the patient/client reports. This would also bridge the gap for nutritional professionals being unsure of what their patient/client’s adherence barriers are. Cost was the main barrier to adherence (41%). Forty-one percent of the participants reported they recommend home-prepared oral nutrition supplements. Of those, 34.4 percent of them provided recipes. Home-prepared ONS could help patients with cost when compared to commercial-prepared ONS. Further research is needed regarding home-prepared ONS as it could decrease cost and taste fatigue. Also, exploring many enhancers to this home-prepared “base” ONS could give the patient/client the ability to experience many types of flavors. Giving them the option to enhance their ONS with many flavors could decrease the likelihood of taste fatigue.

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