Enhancing supportive care in malignant bowel obstruction: A QI project using virtual dietitian-led low-fiber diet education.

Abstract

12068 Background: Malignant bowel obstruction (MBO) is a frequent, debilitating complication in patients with gynecologic malignancies associated with poor prognosis. Low-fibre diet (LFD) is a core component of conservative management; however, adherence is challenging and may be improved with coaching. To address this gap, we implemented a virtual dietitian-led educational intervention and evaluated patient knowledge, attitudes, and practices regarding LFD. Methods: This prospective quality improvement project was conducted at Princess Margaret Cancer Centre between October 2024 and April 2025. Adult patients with gynecologic malignancies who had developed or were at risk of MBO participated in interactive virtual LFD classes delivered by a registered dietitian. Electronic surveys assessed patient knowledge, attitudes, and dietary practices at baseline, post-class, and at two-week follow-up. Outcomes were summarized using descriptive statistics. Results: Of 71 patients approached, 48 (68%) attended the class. Surveys were completed by 43 patients pre-class (61%), 26 post-class (37%), and 18 at follow-up (25%). Median age was 64 years (range 31–79); 32/43 (74%) had ovarian cancer, and 12/43 (28%) had prior bowel obstruction. At baseline, 40/43 (93%) understood the rationale for LFD, but only 26/43 (60%) reported knowing which foods were permitted and 26/43 (60%) which were restricted. Baseline concerns included inadequate healthy food options (32/43, 74%) and limited cultural food compatibility (12/43, 28%). Following the intervention, understanding of permitted foods increased to 24/26 (92%; +32%) and restricted foods to 22/26 (85%; +24%). Confidence that LFD could reduce the risk of MBO improved from 16/43 (37%) to 16/26 (62%; +25%). The virtual format was well received, with 25/26 (96%) feeling comfortable and 22/26 (85%) identifying the class as an important part of their care. At two-week follow up, 15/18 (83%) felt confident in selecting appropriate foods. Adherence was high with 6/18 (33%) following LFD always and 9/18 (50%) most of the time. Despite improved knowledge and adherence, overall satisfaction with LFD remained low (baseline 7/43, 16%; follow-up 3/18, 17%). Challenges including limited food variety, difficulty identifying appealing options, and managing concurrent dietary restrictions, were reported by 9/18 (50%). Quality of life outcomes were mixed, with equal proportions reporting improved, unchanged or worsened: each 6/18, 33%. Conclusions: This quality improvement project demonstrates that a virtual, dietitian-led LFD education is feasible, acceptable, and effective in addressing key knowledge and confidence gaps for patients with or at risk of MBO. Persistent dissatisfaction with LFD highlights the need for future QI efforts focused on developing culturally inclusive resources and integration of multiple dietary needs.