Background: Head and neck (H&N) cancer patients are at high nutritional risk, with a high proportion requiring enteral nutrition secondary to treatment toxicities. The Peter MacCallum Cancer Centre Nutrition Department’s home enteral nutrition (HEN) program managed 260 patients (84% H&N) in 2013-14, including 123 new gastrostomy feeding tube insertions. Dietitians manage H&N cancer patients across the treatment spectrum and are ideally placed to manage their gastrostomy feeding tube needs. This project aimed to implement an advanced practice role of dietitian-led gastrostomy feeding tube management. 

Method: A credentialing program for dietitians to remove and replace gastrostomy feeding tubes was developed encompassing training requirements, competency attainment and maintenance. Multi-disciplinary team endorsement was obtained and included input into development of the program and holding a key role in credentialing dietitians.  A mentoring relationship was established with a health service successfully operating an existing advanced practice program. All requirements for the role were identified, spanning aspects specific to oncology and the health service, legal, and infection control. The program was reviewed by key stakeholders and authorised prior to implementation.

Results: Preliminary results suggest this advanced practice role of dietitian-led gastrostomy feeding tube management over the duration of cancer treatment improves patient centred care, including reduced waiting times for gastrostomy care and improved gastrostomy care coordination. Early results also suggest this role facilitates career progression and leadership opportunities for dietitians, and may improve staff retention.

Conclusions: An advanced practice dietetic role in a cancer setting has demonstrated positive clinical outcomes for patients and had a positive influence on career progression for dietitians. Sustainability requirements to maintain this program have been considered, as well as future evaluations planned to ensure the program continues to meet the needs of clinicians whilst maintaining optimal patient care.