Oncology Registered Dietitian Nutritionists’ Knowledge, Attitudes, and Practices Related to Food Insecurity among Cancer Survivors: A Qualitative Study

Background: Understanding the knowledge, attitudes, and practices pertaining to food insecurity among oncology registered dietitian nutritionists (RDNs) is critical to ensuring that cancer survivors have adequate nutrition—a fundamental component of successful treatment and recovery. Objective: To qualitatively assess oncology RDNs’ knowledge, attitudes, and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis. Design: The qualitative cross-sectional study was conducted from September 2018 to January 2019. Participants and setting: Forty-one oncology RDNs working with cancer survivors in various clinical settings across the United States participated. Main outcome measures: Participants completed a semistructured, in-depth interview via telephone, lasting an average of 49 minutes. Statistical analyses performed: Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program Dedoose was used to organize and analyze the data. Results: Participants defined food insecurity (FI) as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the United Staes, has a greater influence on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs. Conclusions: Although Oncology RDNs have heard of FI, they do not routinely assess patients’ food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs to enhance their ability to screen for and address FI with their patients.