Need for more gastroenterologists specializing in CF care: Survey study
Study calls for training more gastroenterologists in CF, easier patient access
More gastroenterologists with expertise in cystic fibrosis (CF) are needed alongside registered dietitians to provide comprehensive patient care, a survey study has found.
The survey of registered dietitians and gastroenterologists found the involvement of gastroenterologists in caring for CF patients varied widely across specialty centers, with barriers that included a lack of availability and CF expertise among gastroenterologists, and coordination of appointments.
“There is an increased need for gastroenterologist participation and collaboration (particularly in adult centers) in CF alongside registered dietitians to enhance comprehensive patient care,” researchers wrote. “Future efforts should focus on training more gastroenterologists in CF and facilitating easier access to gastroenterologists for the CF population.”
Details of the survey were published in Nutrition in Clinical Practice, in the study “Collaboration between registered dietitians and gastroenterologists in cystic fibrosis care: Results of an international cross-sectional survey.”
CF is marked by the abnormal buildup of thick, sticky mucus in various organs, including the lungs, digestive system, and pancreas. Studies suggest that optimizing nutrition can improve lung function and extend survival, while chronic symptoms affecting the digestive tract can adversely affect nutritional status and reduce quality of life.
CF patients face nutritional, digestive challenges
Given the complex nutritional and digestive challenges CF patients face, registered dietitians and gastroenterologists play an essential role in managing the condition. However, how registered dietitians and gastroenterologists collaborate in CF management has not been evaluated.
To find out, researchers across the U.S. and in Australia conducted an anonymous online survey distributed to registered dietitians and gastroenterologists involved in CF care.
The survey comprised 19 questions, focusing on CF center demographics and details of their professional experience, roles in CF care, reasons for referrals to gastroenterologists, and existing interactions and ways to enhance collaboration.
A total of 131 responded to the survey, 80 of whom were registered dietitians and 51 were gastroenterologists (41 pediatric and 10 adult gastroenterologists).
Future efforts should focus on training more gastroenterologists in CF and facilitating easier access to gastroenterologists for the CF population.
Most (86.2%) registered dietitians were from the U.S., followed by Australia, Canada, New Zealand, and the U.K. Likewise, most gastroenterologists were U.S.-based (82%), with the rest from other countries, such as Australia, Belgium, Canada, Egypt, Jordan, Mexico, Pakistan, Slovenia, and United Arab Emirates.
About two-thirds of dietitians and gastroenterologists had at least five years of experience in CF care (67.5% and 62.7%). Of the registered dietitians who participated in CF centers, 38.7% worked with pediatric patients, 35% with adults, and 26.2% with both. In contrast, a higher proportion of gastroenterologists worked in pediatric care (56.8%), followed by pediatric and adult care (31.3%) and solely with adults (11.7%).
More registered dietitians (45%) said dedicated gastroenterologists were available solely for children diagnosed with CF as compared with what gastroenterologists stated (36.2%). Significantly more dietitians said no gastroenterologists were available at their centers (35% vs. 5.8%).
Significantly fewer dietitians said gastroenterologists saw patients within a CF center than gastroenterologists themselves (36.2% vs. 76.5%). More dietitians also stated gastroenterologists saw patients outside the CF center (40% vs. 21.5%). Likewise, more dietitians said dedicated gastroenterologists were unavailable to patients in clinics integrated within the CF center (23.7% vs. 1.9%).
Barriers to use of gastroenterology referrals
A higher proportion of registered dietitians reported a lack of gastroenterologist’s time and availability as the main barrier to the use of gastroenterology referrals (32.5% vs. 21.5%). Registered dietitians also cited gastroenterologists lacking CF expertise (30%) and coordination of gastroenterology appointments (27.5%) as the other barriers to underusing gastroenterology services.
The most common reasons for gastroenterology referrals included gastrointestinal symptoms, liver problems, colonoscopy screening, pancreatitis (inflammation of the pancreas), pancreatic insufficiency, and nutrition/feeding issues.
More gastroenterologists reported consistent collaboration between the disciplines than registered dietitians (76.5% vs. 36.2%) and as-needed/occasional collaborations (21.5% vs. 3.5%).
A significantly higher proportion of gastroenterologists said there were more collaborative efforts, such as joint clinic visits and participation in patient care activities outside clinic visits.
Many respondents expressed interest in current and future collaborations on quality improvements, development of educational materials, data presentation at local/national meetings, publications, and research. Nearly all gastroenterologists (96%) said registered dietitians respected their role in CF care, whereas two-thirds (66.2%) of dietitians stated their gastroenterologist colleagues respected their role in CF.
“Our survey results highlight the wide variability in the involvement of gastroenterologist providers in CF care,” the researchers wrote. “Decreased availability and lack of CF expertise among gastroenterologists and coordination of gastroenterology appointments were barriers to gastroenterology services.”
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