Oral nutritional supplements within the nutrition therapy : Prescription and adherence from a dietetic practice perspective

Abstract: The overall aim of this thesis was to increase knowledge and deepen understanding on prescription of and adherence to oral nutritional supplements (ONS). In Paper I, the reporting quality of interventions with ONS in publications of randomised controlled trials was explored. In Paper II, adherence to ONS prescriptions from dietitians to hospital outpatients in clinical practice was assessed. Further, an evaluation of the population characteristics and ONS prescription characteristics was performed. In Papers III and IV, dietitian and patient experiences of prescribing or being prescribed and using ONS were explored through qualitative interviews.The reporting quality of ONS interventions was found to be incomplete, making it hard to interpret trial findings and replicate them in clinical practice. The articles mainly lacked a description of intervention procedures, provider and location(s), but an improvement was observed in articles published after 2011. Adherence to ONS was found to be high (> 75%) among hospital outpatients prescribed ONS in clinical practice. The population was relatively young (mean age 67 years), and the two most common medical diagnoses were cancer and gastrointestinal disease. The prescriptions were individually tailored by dietitians, usually encompassing several flavours (mean 4.2) and 1–3 bottles/day. In the dietitian interview study, shared tailoring of the ONS prescription and provision of behaviour change support were identified as important aspects when dietitians prescribe ONS. In the patient interview study, ONS were described as a one-dimensional remedy: contributing with nutrients, but unable to resolve the situation of altered eating. Additionally, ONS usage was described as regulated autonomously based on the priority given to nutrition in everyday life.In conclusion, this thesis shows that prescription of and adherence to ONS are complex processes, which tend to be underestimated in the ONS literature. Adherence to ONS was high, which might be explained by population characteristics and the dietitian-tailored prescriptions fulfilling criteria for appropriate ONS prescriptions. The interview studies provided insights into nutrition therapy with ONS from both the dietitian and the patient perspective. The findings indicated that ONS should be prescribed using a person-centred care approach, with patients viewed as an active part in nutrition therapy.