Women's perspectives toward their nutritional counseling for eating disorders: a qualitative internet-based study in Israel

Systematic Review of Patient Preferences and Experiences Regarding Dietetic Outpatient Care

INTRODUCTION

Dietitians play a crucial role in delivering medical nutrition therapy in outpatient settings where overnight admission of patients is not required. Despite the increasing focus on value-based healthcare and patient-reported measures (PRMs), there have been no recent reports synthesising patient experiences of dietetic outpatient care. This study aims to synthesise existing literature on patient preferences and experiences of outpatient dietetic care and to provide updated guidance for dietitians to improve patient-centred care.

METHODS

A qualitative systematic review with meta-ethnography was conducted. The review included studies that reported patient experiences of dietetic care provided at outpatient settings detailed through focus groups, interviews, surveys or questionnaires, regardless of language, year or nationality. Participants' quotes and second-order concepts were extracted verbatim and synthesised. Main themes and sub-themes were then developed.

RESULTS

Five database searches yielded 5786 articles. After title and abstract screening and full-text review, 72 articles were included. Three overarching themes were identified: (1) the process of accessing and receiving dietetic care was problematic; (2) the delivery and content of dietetic advice were suboptimal at times and (3) personal attributes of the dietitian and a desire for speciality expertise influenced perceptions of the quality of dietetic care.

CONCLUSION

The findings from this study provide actionable insights for dietitians to tailor their outpatient services by improving accessibility, refining the delivery of care and enhancing specialised expertise to meet individual patient needs and expectations effectively.

Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic

Little is known about the therapeutic alliance (TA) formed with different professionals in multidisciplinary eating disorder (ED) treatment, particularly in the context of online treatment during the COVID-19 pandemic. We aimed to conduct a pilot study during the COVID-19 pandemic examining characteristics of patients' TA with their dieticians and psychotherapists, associations between patients' and therapists' views of the TA, and relationships between psychological characteristics and TAs. Sixty-three patients with EDs and their treating psychotherapists and dieticians were surveyed during the COVID-19 pandemic using the Working Alliance Inventory (WAI-S). Spearman correlation tests were used to examine associations between variables. Positive associations were found between the TAs examined. Concordance was stronger in patient-dietician dyads than in patient-psychotherapist dyads. Severe ED psychopathology was associated with weaker TA (bond subscale). General psychopathology was associated with weaker TA with the dietician (task subscale). Given that several differences were found between the TAs of treatment dyads, further longitudinal studies are needed to validate our pilot findings and to investigate multidisciplinary TAs and their impact on treatment outcomes in online ED treatment settings during the COVID-19 pandemic, as well as in other treatment settings (e.g., in-person settings). This study will contribute to a deeper understanding of the dynamics of TAs in multidisciplinary ED treatment and inform the development of more effective interventions.

"I Need Someone to Help Me Build Up My Strength": A Meta-Synthesis of Lived Experience Perspectives on the Role and Value of a Dietitian in Eating Disorder Treatment

Dietitians are included in eating disorder (ED) treatment teams for their expertise in nutrition. However, little is known about an individual's experience of dietetic intervention as part of their ED treatment and what they value as part of dietetic care. Therefore, the aim of this review was to synthesise the available qualitative literature to understand the role and value of a dietitian in ED treatment from the perspective of individuals with lived experience. Six databases and Google Scholar were searched and a thematic synthesis and meta-synthesis of fifteen studies were conducted. Four themes were constructed from the data: (1) "guidance and structure"-Provision of nutrition knowledge and skills; (2) "having all my bases covered"-Dietitians as part of a multidisciplinary team; (3) Challenges in nutritional treatment; and (4) "it was my treatment and my recovery"-Person-centred dietetic treatment. Across all identified themes was the cross-cutting theme of a shared treatment journey between the dietitian and the individual receiving treatment. These findings support dietitians having a role that is not limited only to the provision of nutrition treatment in ED care and illustrates the importance of dietitians engaging with clients by centring on the individual's needs and preferences. Further understanding helpful dietetic treatment components and identifying gaps in training is needed to develop these broader roles for dietetic care.