Dietitians

Improving a person’s quality of life with a life-limiting illness through symptom control and targeted nutritional support and education that reflects what is important to them. 

Scope of Practice

Dietitians are trained in nutrition assessments which may involve assessing a person’s nutritional status, dietary intake and food preference, along with identification of nutrition related symptoms and other problems which may impact a person’s ability to eat. Dietitians also offer nutrition support through the provision of dietary counselling, and development of personalised meal plans. [1,2]

The Dietitian Scope of Practice is available on the Dietitians Association of Australia (DAA) website.

Dietitians may have roles of advanced or extended scope of practice which reflect a level of expertise within or beyond the established contemporary scope of practice. [3]

  

Check out the relevant evidence for Dietitians:

Clinical Evidence

PubMed Search

Review Collection

Role in Palliative Care

Palliative care provides a support system for people living with a life-limiting condition to live as actively as possible, with dignity, for as long as possible. It is active and supportive care that seeks to maximise quality of life. [4] It is useful well before death and not limited to care of the dying. [5]

In helping people with palliative care needs, a dietitian: [5-9]

  • recognises that eating has an emotional, social and cultural significance and that changes in food intake may be distressing for the person, family and carers
  • assesses the person’s symptoms which may interfere with appetite or eating and their sense of what is important
  • creates with the person realistic goals and expectations to enhance quality of life in the face of decline and impending death within the context of a therapeutic relationship
  • assesses the person’s
    • diet or changes in diet
    • understanding of nutrition and relevance for quality of life
    • need for nutritional supplements
    • help or lack of help from a carer or carer network
  • supports the multidisciplinary team with the nutritional management of symptom-related problems such as loss of appetite, altered taste and smell, dysphagia or cachexia
  • can facilitate discussions on the potential benefits and burdens of supplemented oral, enteral and parenteral nutrition
  • advises on preparation / fortification / supplementation / relaxation of previous dietary restrictions as appropriate for the person
  • helps with the management of digestive issues, such as poor appetite, nausea or constipation
  • educates the person and carers about safe eating and changes with deterioration
  • works closely with the interdisciplinary team to ensure psychological and emotional support is provided, as required
  • works closely with a speech pathologist, who will assess and address eating and swallowing problems.

Dietitians may work in palliative care as only part of their role or have a palliative care caseload with a specialist role. This may be as a member of a multidisciplinary team or a sole practitioner.

Dietitians Association of Australia (DAA) have published the Role Statement for Accredited Practising Dietitians practising in the area of Oncology (206kb pdf). [8]

The RACGP aged care clinical guide (Silver Book 2019) recognises the role of  allied health professionals in team care arrangements for a proactive person-centred approach to palliative care. [10] Palliative Care Australia also recognises the importance of access to information and support from a diverse range of allied health services for patients, families and carers. [11]

The role of allied health in palliative care is to provide the person with as much therapy time as possible. The goal of allied health in palliative care is around maintaining and improving functional ability. There may be a blurring of roles across allied health professions in palliative care more than in other care contexts.

Allied Health workers provide care in all practice settings. For further information on the specific area of practice go to Practice Settings.

Practice Support

Useful evidence-based information and resources on rehabilitative palliative care are available from Hospice UK.

A section on CareSearch includes examples of dietetics practice and reflections in palliative care by way of allied health blogs, case stories and the voice of experience.

Using Evidence

Although dietitians are familiar with evidence and evidence-based practice through their training and continuing professional development (CPD), keeping up to date can be time-consuming.

CareSearch provides the tools to help find and use evidence. This includes PubMed searches on a multitude of topics and sections dedicated to Searching for Evidence and Using Evidence in Practice.

For support in applying evidence in practice, check out the Journal Club Basics page on CareSearch which provides information on the benefits of and practical pointers in setting up or joining a journal club.

The International Centre for Allied Health Evidence at University of South Australia has a number of resources to support translation of evidence into practice.

Guidelines

Guidelines specific to dietitians and palliative care in Australia have not been published, however, the Palliative Care Service Development Guidelines 2018 (340kb pdf) provides an overview of dietitians (as part of allied health) in specialist palliative care. [11]

Guidelines for the role of dietitians in the nutritional management of cancer have been developed:

Resources for Patients, Carers and Families

Dietitians have an important role in supporting patients, carers and their families with information. The CareSearch Resources for Patients, Carers and Families provides links to useful information including fact sheets and printable resources Dietitians can download and share.

Education

The National Palliative Care Strategy 2018 (6.01MB pdf) lists as a priority the ability of medical, nursing and allied health graduates to identify and address people’s palliative care needs (Priority 2.1, p15). [12] This is also highlighted for the acute sector in the Guiding Principles of the National Consensus Statement: essential elements for safe and high-quality end-of-life care which also recognises the importance of the role of an interdisciplinary team. [13]

Courses

CareSearch lists a collection of  Palliative Care eLearning resources for allied health for independent learning.

  1. Allied Health Professions Australia (AHPA). Dietetics [Internet]. 2017 [cited 2019 Nov 5].
  2. Dietitians Association of Australia (DAA). What Dietitians Do [Internet]. 2019 [cited 2019 Nov 5].
  3. Government of South Australia, SA Health. Allied Health Practice Profiles: Dietetics (321kb pdf). Adelaide (SA): SA Health; 2017.
  4. Pautex S. Rehabilitation for Palliative Care and End-of-Life Management. In: Masiero S, Carraro U, editors. Rehabilitation Medicine for Elderly Patients. Cham, Switzerland: Springer International Publishing; 2018.
  5. The contribution to palliative care of allied health professions. In: Watson MS, Ward S, Vallath N, Wells J, Campbell R, editors. Oxford Handbook of Palliative Care. 3rd ed. Oxford: Oxford University Press; 2019.
  6. Richardson R, Davidson I. The contribution of the dietitian and nutritionist to palliative medicine. In: Cherny N, Fallon M, Kaasa S, Portenoy RK, Currow DC, editors. Oxford Textbook of Palliative Medicine. 5th ed. Oxford: Oxford University Press; 2015.
  7. Cancer Council NSW. The palliative care team [Internet]. 2019 [cited 2019 Nov 5].
  8. Dietitians Association of Australia (DAA). Oncology Role Statement (205kb pdf). Canberra: DAA; 2017 Dec.
  9. Payne C. Dietetics and Nutrition in Palliative Care. In: MacLeod RD, Van den Block L, editors. Textbook of Palliative Care. Cham, Switzerland: Springer International Publishing; 2019.
  10. The Royal Australian College of General Practitioners (RACGP). RACGP aged care clinical guide (Silver Book). RACGP; 2019.
  11. Palliative Care Australia (PCA). Palliative Care Service Development Guidelines. Canberra: PCA; 2018 Jan.
  12. Australian Government Department of Health. National Palliative Care Strategy 2018. Canberra: Australian Government Department of Health; 2019 Feb 22.
  13. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Consensus Statement: essential elements for safe and high‑quality end-of-life care. Sydney: ACSQHC, 2015.

Case Stories

Video

Online Support

Special Interst or Support Groups

Last updated 14 November 2019