Chronic Pancreatitis: Towards a Comprehensive, Patient-Centred, Evidence-Based Model of Nutritional Care

Background Chronic pancreatitis (CP) is a complex disease with a variety of clinical features. Main symptoms of CP are crippling abdominal pain, steatorrhoea, and weight loss, frequently requiring hospitalisation.

Over time, fibrotic changes lead to progressive reductions in pancreatic exocrine and endocrine function, resulting in pancreatic exocrine insufficiency (PEI), endocrine insufficiency (eventually diabetes mellitus) and chronic, intractable abdominal pain. PEI results in fat malabsorption; clinical consequences of PEI include weight loss and associated malnutrition.

Treatment of PEI and associated clinical consequences are priorities in nutritional management of CP.

Primary Aim To develop an evidence-based therapeutic intervention to treat nutritional deficiencies and improve quality of life of patients with CP Objectives Undertake a systematic literature review to determine the nature and effectiveness of interventions to treat nutritional deficiencies in patients with CP.

Understand how people with CP perceive their nutritional status and treatment of nutritional deficiencies. Determine the current nutritional management of patients with CP by healthcare professions in the UK.

Co-develop an evidence-based intervention to treat nutritional deficiencies and improve nutritional status and quality of life (QoL) in people with CP. Methods Objective 1 will involve the completion of a systematic review. Protocols have been written in collaboration with NIHR North East Research Design Service.

Objective 2 will be achieved using semi-structured interviews of service users. Participants will be identified and recruited using clinical lists of CP patients and via patient support groups.

For objective 3, an online survey will be developed and disseminated to health care professionals (HCP) working with CP patients. Participants will be identified via well-established specialist networks.

Objective 4 will involve co-design workshops, attended by patients and a range of HCP, creating an evidence-based intervention. Participants will be recruited from earlier stages of the project.

Timelines for delivery Objectives 1-3 will be completed in the first 16 months; objective 4 will take a further 14 months. Publications linked to objectives have been scheduled throughout. Time to write has been allocated at all stages of the fellowship, increasing in the final 12 months.

Anticipated impact and dissemination This research will address important gaps research by: a systematic review of nutrition in CP; pioneering research to explore nutritional needs of people suffering from CP and treatment offered from the service users' perspectives; and co-design of treatment with HCP and patients which will ensure the development of a patient-centred intervention.

This body of work will be the first to comprehensively evaluate the effectiveness of nutritional interventions in CP.

With a uniquely patient-centred approach, this research will investigate patient perceptions of their nutritional management and will be the first of its kind worldwide. I will conduct the first UK-wide analysis of nutritional management of CP by different healthcare professions. Finally, I will use co-design to develop a comprehensive, evidence-based, patient-centred nutritional intervention.

Dissemination will be by journal publication, presentation at national and international conferences, via our national pancreatic dietetic body, social media, and crucially, by working closely with national and regional patient support groups.