Nutritional screening and recommendations for patients with incurable cancer in palliative care: Delphi study

BACKGROUND AND AIMS: The Nutritional screening algorithm for patients with incurable cancer receiving palliative care (NutriPal) was recently created and the patients were classified into four degrees of nutritional risk. Previous study has shown that NutriPal is associated with nutritional and laboratory parameters and may have prognostic value for short-term mortality. However, structured recommendations aligned with each risk category have not yet been developed. This study aimed to develop and refine nutritional recommendations aligned with NutriPal risk categories, establish their content validity through expert consensus, and assess their perceived clinical applicability in patients with incurable cancer receiving palliative care. METHODS: The initial version of the nutritional recommendations was prepared based on a literature review and brainstorming. Using the Delphi method, experts (n = 15) assessed the clarity, relevance, and importance of the items. Consensus was defined as ≥85% agreement. Pretests were conducted with clinical Registered Dietitian Nutritionists (n = 29) to evaluate the perceived clinical applicability of the recommendations. Items with ≥15% disagreements or doubts were reformulated and submitted to a second pretest. RESULTS: Fifteen nutritional recommendations were developed across six domains. Four rounds of Delphi and two pretests were needed for consensus to be reached. Most modifications occurred after the first Delphi round and the first pretest, while no items were added or removed during the process. The final recommendations were organized according to NutriPal risk categories within six domains: re-administration of NutriPal; symptom control; nutrient supply; nutritional assessment; nutritional support; and comfort. CONCLUSION: This study developed a set of expert consensus-based nutritional recommendations aligned with NutriPal risk categories and demonstrated their perceived clinical applicability among dietitians.