According to Jolein Iestra, in an ever changing medical environment, scientific research is essential for dietary departments to be able to set good priorities. This kind of research concentrates on predictive factors in patient populations (prognosis) and the effects of nutritional interventions (proof). Iestra illustrates this with four studies. By identifying changes in the side effects of intensive cancer treatments, she shows that patients who need parenteral feeding can be selected in a better way. By describing the differences in weight recovery following intensive cancer treatments, she points out a subgroup of patients that need to have extra nourishment after they have been discharged. By analyzing the relationship between food, lifestyle, and mortality among patients who have had heart attacks, she provides a foundation for the importance of providing information on nutrition and lifestyle to these patients. Using a systematic literature review, she also shows that among heart patients, the scope of health benefits resulting from nutritional and lifestyle changes are comparable to the health benefits of commonly used medicines.
But to set priorities, research data alone are not enough, says Iestra. They have to be weighted within the context of ethical values and the social context. In the hospital, there is a great temptation to set priorities completely according to the critical nature of diseases and short-term effects. Reflecting on ethical values such as “the interest of the patient,” “autonomous choices,” and “distributive justice” can help to resist this temptation.
Jolein Iestra
Prognosis, proof and priorities in dietetic practice
PhD advisor 1: Prof. D.E. Grobbee
PhD advisor 2: Prof. W.A. van Staveren
PhD advisor 3: Prof. D. Kromhout