Effect of communication mode on disclosure of nutrition impact symptoms during nutrition intervention delivered to people with upper gastrointestinal cancer

Abstract Introduction Individuals diagnosed with upper gastrointestinal cancers experience a myriad of symptoms directly related to their tumour burden and antineoplastic therapies. Many of these nutrition impact symptoms (NIS) including nausea, anorexia, pain, dysphagia, and diarrhoea, compromise a person’s ability to adequately meet their nutritional requirements leading to malnutrition, reduced quality of life and poorer survival. Electronic health (eHealth) has been lauded as a potential strategy for improving the delivery of nutrition interventions by improving early and sustained access to dietitiansto address both NIS and malnutrition. This study aimed to explore whether the mode of nutrition intervention delivery (telephone or mobile app) affected participant disclosure of NIS during an early and intensive nutrition intervention. Methods Participants in the intervention groups received a regular nutrition intervention for 18 weeks from a dietitian via telephone or mobile application (App). The research dietitian maintained a set of participant records, collecting data from each week of intervention delivery including reported NIS. Poisson regression determined the proportion of individuals who reported NIS compared between groups. Univariate and multiple regression analyses of demographic variables were used to explore the relationship between demographics and reporting of NIS. The trial was registered prospectively on the Australian and New Zealand Clinical Trial Registry (Trial ID: ACTRN12617000152325 27th January 2017). Results The incidence of reporting of NIS was more than 1.8 times higher in the telephone group (n=38) compared to the mobile app group (n=36). Telephone group allocation also predicted a higher likelihood of disclosure of self-reported symptoms of fatigue, nausea, and anorexia throughout the intervention period. Conclusion Caution should be applied when introducing virtual health care approaches as standard of care. A trusting therapeutic relationship built on human connection is fundamental and may not be achieved with current models of mobile health technologies. Incorporation of video and/or telephone interaction is likely to be imperative in establishing this connection between patients and health care providers.