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© 2005 The American Society for Nutritional Sciences J. Nutr. 135:1253-1255, May 2005

Symposium: Relative Bioactivity of Functional Foods and Related Dietary Supplements

Functional Foods: Delivering Information to the Oncology Nurse1,2

Glen T. Cameron3 and Mugur V. Geana

Missouri School of Journalism, Columbia, MO 65211

3To whom correspondence should be addressed. E-mail: geanam{at}mizzou.edu.


   ABSTRACT
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 ABSTRACT
METHODS
 RESULTS
 CONCLUSION
 LITERATURE CITED
 
Recent research suggests a beneficial role of nutrition as possible supportive therapy for cancer patients. A national survey of oncology nurses has shown that nutrition-related issues are an important subject discussed during nurse–patient meetings. The authors applied the activation theory of information exposure to oncology nurses in regard to nutrition information. Findings suggest that oncology nurses who consider nutrition important at a personal level tend to discuss nutrition more with patients and to seek more information about nutrition and cancer. Personal rather than professional motives appear to be triggers for the information search. Implications for health care communication professionals are discussed.

KEY WORDS: • nutrition • cancer • oncology • nurse

Any research saga that has a social component culminates with the need to communicate the research findings or its implications to the targeted population. In today’s world, dominated by the contrast between information overload and our selectivity regarding the media channels we use to gather information, having the right communication tool could prove essential for the success of any research enterprise.

Things get even more complicated when the subject is perceived by the audience as being a sensitive issue. In the United States, 1,285,000 new patients were diagnosed with cancer in 2002. In the same year, 555,000 people perished due to the illness (1).

Nurses, because of their close interaction with patients and patients’ perception of the nurse’s role (2), are an efficient channel for distributing health messages. For this reason, nurses’ perception and opinions of such nutritional products could have an important impact on improvements in diet for patients. Research by Lev and Ovwen (3) demonstrated the role of the oncology nurse as a social model for patient learning and confirmed the efficacy of patient education interventions structured according to Bandura’s social learning theory.

Nursing theorists emphasize the central role of patient–nurse communication (4) and agree on the key role of the nurse in ensuring patient compliance of major impact on both disease outcome and the quality of life of the patient. This is an extremely valuable approach, especially considering the modern diagnostic and therapeutic interventions that encourage an approach to cancer disease as a chronic illness.

Carr-Hill et al. (5) and Cullum (6) suggested that nurses have a significant influence on patient outcomes in areas such as nutrition, patient hygiene, education and rehabilitation, and pain control and management.


   METHODS
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RESULTS
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The Missouri School of Journalism, in collaboration with the School of Nursing at the University of Missouri, conducted, through its specialized research outlet, the Center for Advanced Social Research, a national survey of members of the Oncology Nursing Society (response rate of 64%). The survey data were used to assess the level of communication about nutrition in general and functional foods and dietary supplements in particular between oncology nurses and patients, and also to identify triggering elements that could be used to stimulate nurses’ involvement with learning and sharing information about functional foods.


   RESULTS
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The results were impressive. Of the oncology nurses, 96.7% said that they feel responsible for providing nutritional advice to their patients, with 85.5% of the nurses actually discussing nutrition issues with the patients. Whereas 63% of the oncology nurses state that they frequently receive questions about nutrition from their patients, 78.6% actually make nutritional recommendations to their patients. Quality of life of the cancer survivor was the foremost rationale identified by nurses as their justification for providing nutritional advice:

Although nurses had a consensus regarding the importance of nutrition as supportive therapy for the cancer patient, the level of knowledge about dietary supplement vs. functional foods showed a notable gap: 99.7% of the nurses declared that they are familiar with the concept of dietary supplements, whereas only 15.8% declared the same about functional foods.

Increasing nurse’s knowledge of functional foods represents an important component in the quest for delivering accurate information about these products to cancer patients.

Among all medical service providers, the nurses report the greatest involvement with patients. Empirical studies (7–10) showed that, with respect to communication between nurses and cancer patients, nurses can have "blocking" and "facilitating" conduct, from stimulating patient "problem confession" to switching to other topics of discussion. Research by Lev et al. (3) showed the perception of the nurse by cancer patients was as a model and that identifying desired behavior in the nurse (or by listening to the model-nurse describing desired behavior) increases the confidence of the patient to achieve similar behavior. Bandura’s social cognitive theory (11) emphasizes the role of the social model as a determinant for changing social behavior. Bandura identified self-observation (desired behavior), judgment (comparison to the model), and self-efficacy (individual self-response to the behavior change) as criteria to assess the ability to control behavior.

By using Zaichkowsky’s Personal Involvement Instrument (12), the authors assessed whether information about functional foods and the nurse–patient communication process modify nurses’ nutritional and information search behavior and whether the modified behavior could serve as a social model to persuade behavior change in cancer patients.

The research has shown that an important component geared toward increased involvement is represented by the perception of the nurse that the information delivered is not only important at a professional level (better care for the patient), but it also carries a variable degree of personal importance (Fig. 1). The more the information learned is perceived by nurses as also delivering personal benefits, the more the acceptance of the information and the desirability to apply it in their routine practice and to communicate it to cancer patients.



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  		FIGURE 1 Standard continuous education models address the professional benefits (A). In the case of functional foods, including information regarding possible personal benefits (B) increases involvement and enhances the social model role of the oncology nurse.

 
The second important triggering component in the equation to increase involvement of the oncology nurse with functional foods is the nurse–patient communication itself (Fig. 2). As stated earlier, the patient perceives the nurse as a social model. Delivering pertinent initial information about functional foods that is used with success in the communication process (thus generating a certain degree of gratification) stimulates the active search for similar (or related) information to be further used in the nurse–patient communication process.



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  		FIGURE 2 Increasing knowledge about nutrition and obtaining positive results by clinically applying the acquired knowledge increases the willingness of the nurse to actively search for information. This will help to enhance her role as a social model for the cancer patient and also will provide her with directions for further personal gain.

 
This cyclical approach is beneficial for both the nurse and the patient, and could prove an essential message component in the strategic communication campaign under development in the last year of funding.

The first step in this process is to provide the nurse with useful, novel information beyond what is currently available. To identify the nature and the extent of information about nutrition offered to nurses through professional peer-reviewed journals, the authors conducted a content analysis of the 4 most often read professional journals over a 2-y period. Of the 276 articles analyzed, only 14 (5.07%) made some kind of reference or discuss about nutrition. Of these articles (at a paragraph level), only 6.56% mention a functional food and only 2.18% mention learning about nutrition as having a positive value for the nurse.


   CONCLUSION
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 ABSTRACT
 METHODS
 RESULTS
 CONCLUSION
LITERATURE CITED
 
Considering the above results, it is evident that one of the first steps to be taken is to conceive an outlet to distribute initial information about functional foods to the oncology nurses, followed by designing a dedicated information base that the interested nurses can access and use to increase their knowledge, hence their involvement, with the patient as the ultimate beneficiary of this process.


   FOOTNOTES
 
1 Presented as part of the symposium "Relative Bioactivity of Functional Foods and Related Dietary Supplements" given at the 2004 Experimental Biology meeting on April 17, 2004, Washington, DC. The symposium was sponsored by the American Society for Nutritional Sciences and in part by the USDA. The proceedings are published as a supplement to The Journal of Nutrition. This supplement is the responsibility of the Guest Editors to whom the Editor of The Journal of Nutrition has delegated supervision of both technical conformity to the published regulations of The Journal of Nutrition and general oversight of the scientific merit of each article. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, editor, or editorial board of The Journal of Nutrition. The Guest Editor for the symposium publication is Elizabeth Jeffery, Department of Food Science and Human Nutrition, University of Illinois at Champaign-Urbana, Urbana, IL. Back

2 This research was supported by USDA/IFAFS grant #00–52102–9695. Back


   LITERATURE CITED
TOP
 ABSTRACT
 METHODS
 RESULTS
 CONCLUSION
 LITERATURE CITED
 

1. Bureau of Census (2002) Statistical Abstract of the U.S., 2002: The National Data Book. Health Condition, Disease and Disability 2002 http://www.census.gov/prod/2003pubs/02statab/health.pdf [accessed February 5, 2004].

2. Corner, J. (1997) Beyond survival rates and side effects: cancer nursing as therapy. Cancer Nurs. 20:3-11.[Medline]

3. Lev, E. L. & Ovwen, S. V. (2000) Counseling women with breast cancer using principles developed by Albert Bandura. Perspect. Psych. Care 36:131-138.

4. Catalano, J. T. (2000) Nursing Now: Today’s Issues, Tomorrow’s Trends 2nd ed. 2000 F. A. Davis Philadelphia, PA.

5. Carr-Hill, R., Dixon, P., Gibbs, I., Griffits, M., Higgins, M., McCaughan, D. & Wright, K. (1992) Skill Mix and the Effectiveness of Nursing Care 1992 Centre for Health Economics University of York.

6. Cullum, N. (1997) Identification and analysis of randomised controlled trials in nursing: a preliminary study. Qual. Health Care 6:2-6.[Abstract/Free Full Text]

7. Kruijver, I. P., Kerkstra, A., Bensing, J. M. & van de Wiel, H. B. (2000) Nurse-patient communication in cancer care: a review of the literature. Cancer Nurs. 23:20-31.[Medline]

8. Heaven, C. M. & Maguire, P. (1996) Training hospice nurses to elicit patients concerns. J. Adv. Nursing 23:280-286.[Medline]

9. Booth, K., Maguire, P. M., Butterworth, T. & Hillier, V. F. (1996) Perceived professional support and the use of blocking behaviours by hospice nurses. J. Adv. Nursing 24:522-527.[Medline]

10. Maguire, P., Fairbairn, S. & Fletcher, C. (1986) Consultation skills of young doctors: II—most young doctors are bad at giving information. Br. Med. J. (Clin. Res. Ed.) 292:1576-1578.

11. Bandura, A. (1986) Social Foundations of Thought and Action 1986 Prentice-Hall Englewood Cliffs, NJ.

12. Zaichkowsky, J. L. (1985) Measuring the involvement construct. J. Consum. Res. 12:341-352.





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