A patient-mediated implementation strategy to improve nutrition care delivery for esophageal and gastric cancer - a study protocol for a pilot randomized controlled trial

Sep 23, 2026

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Nutrition counseling before gastrointestinal surgery can enhance quality of life, treatment tolerance, and surgical recovery, yet fewer than half of patients with esophageal and gastric cancer receive such counseling despite high malnutrition risk. The STRONG implementation strategy addresses this gap using an electronic health record order set, a web-based dashboard for patient-reported nutrition information, and a patient prompt list for the dietitian encounter. In a pragmatic pilot trial, 80 patients will be randomized 1:1 to STRONG or usual implementation to assess feasibility, acceptability, and preliminary effectiveness and implementation outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Background

Methods

Discussion

Trial registration

Contributions to the literature

Keywords

Background (clinical context)

Turner et al. Journal of Health, Population and Nutrition (2026) 45:37 [https://doi.org/10.1186/s41043-025-01208-3](https://doi.org/10.1186/s41043-025-01208-3) Journal of Health, Population and Nutrition STUDY PROTOCOL Open Access A patient-mediated implementation strategy to improve nutrition care delivery for esophageal and gastric cancer: a study protocol for a pilot randomized controlled trial Kea Turner 1,2*, Ashwin Somasundaram2,3, Brent J. Small 1,2, Jeanine Milano4, Christina Santiago4, Olivia Sprow 1, Emma Hume 1, Nazanin Khajoueinejad5, Nekesha McKinnie5, Allan Lima Pereira5, Andrew Sinnamon5, Jennifer B. Permuth5,6, Amir Alishahi Tabriz5,7 and Jose M. Pimiento5 Abstract Background Nutrition counseling before gastrointestinal surgery can improve patients’ quality of life, treatment tolerance, and surgical recovery. Nutrition counseling is especially important for individuals diagnosed with esophageal and gastric cancer, who are at high risk of malnutrition. Despite the increased risk for mal nutrition, less than half of individuals diagnosed with esophageal and gastric cancer receive nutrition counseling before surgery. To address this practice gap, the Support through Remote Observation and Nutrition Guidance (STRONG) implementation strategy was developed. Methods STRONG includes three theory-informed strategies: an electronic health record order set for a standardized protocol that specifies the timing and amount of nutrition counseling that should be received, collection and visualization of patient-reported nutrition information in a web-based dashboard, and a question prompt list for the patient-dietitian encounter. Patients (N = 80) will be 1:1 randomized to STRONG or implementation as usual in this pilot trial. The trial will be pragmatic in design and STRONG will be implemented with existing clinic teams and workflows. The study’s primary aim will be to assess feasibility and acceptability against pre-planned benchmarks and secondary aims include collecting preliminary data on effectiveness and implementation outcomes that will support a future definitive hybrid implementation-effectiveness trial. Discussion Pilot studies play a critical role in implementation research by ensuring that strategies and proposed study methods are feasible prior to conducting a definitive trial. Positive findings from this line of research could support definitive testing of a patient-mediated implementation strategy to improve nutrition care access and delivery for cancer patients at high risk of malnutrition. Trial registration ClinicalTrials. gov NCT06497569 . Registered on July 11, 2024, prior to participant enrollment. *Correspondence: Kea Turner [kea.turner@unc.edu](kea.turner@unc.edu) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/. Turner et al. Journal of Health, Population and Nutrition (2026) 45:37 Page 2 of 14 Contributions to the Literature • Patient-mediated implementation strategies aim to improve the delivery of healthcare through patient engagement and can affect patient

FAQs

What problem does the STRONG strategy target in patients with esophageal and gastric cancer?

The strategy targets the practice gap where fewer than half of patients receive nutrition counseling before surgery despite high risk for malnutrition.

What components are included in the STRONG implementation strategy?

STRONG includes an electronic health record order set, a web-based dashboard to collect and visualize patient-reported nutrition information, and a question prompt list for the patient–dietitian encounter.

How will the pilot randomized controlled trial evaluate the STRONG strategy?

The trial will randomize 80 patients 1:1 to STRONG versus usual implementation, assessing feasibility and acceptability against predefined benchmarks, with secondary aims collecting preliminary effectiveness and implementation outcomes.

Sep 23, 2026

Uploaded by acoobca