‘Highly effective care’ boosted by collaboration between GI dietitians, psychologists

Most patients and health care providers would agree that interdisciplinary care leads to the most successful patient outcomes.

In gastroenterology, two key members of a care team — GI dietitians and GI psychologists — work together to improve their patients’ nutritional status, manage gastrointestinal symptoms and enhance food-related and overall quality of life.

When the dietitian calls in the psychologist

GI dietitians provide guidance on evidence-based dietary therapies for specific GI conditions. While it is common, and often helpful, for patients with these conditions to modify their diet to control symptoms and/or manage their disease, sometimes patients struggle with over-restriction of their diet, which can impair their nutritional status, mental health and quality of life.

The dietitian may reach out to the psychologist when a patient appears to be resistant or reluctant to implement diet recommendations, despite adequate education by the dietitian on the importance and safety of liberalizing their diet. In this case, the psychologist can work with the patient to understand potential barriers, engage in problem-solving and help the patient develop the motivation and confidence to make changes.

Some patients may require restrictive diets, per medical necessity, to control their disease. The diagnosis of a diet-controlled disease may be accompanied by emotional, mental and physical distress associated with having to significantly alter their diet. The psychological burden of implementing a restrictive diet can affect a patient’s adherence to medically necessary diets, ultimately worsening their disease activity. Therefore, restrictive dietary therapies should be implemented under the close, collaborative care of the dietitian and psychologist to improve patient outcomes.

The dietitian may also loop in the psychologist when dietary therapy and medical interventions have been optimized, but a patient continues to experience ongoing GI-related concerns or complications. Patients may report worse symptoms with increased bouts of stress, anxiety or depression, and some patients may feel helpless, thinking they have exhausted all their treatment options.

A referral to a GI psychologist can help the patient better navigate perception of their disease management, develop a plan for the possibility of additional interventions and guide the patient through the process of accepting their disease course. When it is determined that a referral to a psychologist is warranted, it is beneficial for the dietitian to provide a summary of the patient’s case and reason for referral, to ensure treatment goals are aligned.

When the psychologist calls in the dietitian

GI-focused psychotherapy typically focuses on one or both of the following goals: to help a patient adjust to living with their condition and to develop behavioral strategies to manage ongoing symptoms. Diet and eating behaviors are frequently discussed in therapy, as diet can be impacted by illness or treatments, and because diet may be seen as a potential driver or alleviator of symptoms.

Understandably, many patients with GI disorders develop fears about food and may utilize dietary restriction in the hopes of controlling symptoms. When it is determined that a patient’s diet has become overly restricted, an approach called “exposure therapy” may be offered. In this therapy, the patient confronts the feared foods in a supportive, gradual approach spanning several weeks or months.

Exposure therapy can be greatly enhanced by the involvement of a GI dietitian, who can provide insight into foods that are more likely to be easily tolerated and can provide important guidance to the psychologist regarding the patient’s specific dietary needs to ensure that exposures will be successful and safe for the patient.

Many patients, including those with inflammatory bowel disease, express uncertainty and anxiety about the role of diet in managing their disease. In these cases, recommending that the patient meet with a GI dietitian can help ensure that they receive information from a reliable source — one who can provide adaptive guidance relevant to their current disease state.

Staying in the loop

To improve patient-centered care, it is important for the GI dietitian and GI psychologist to communicate regularly with one another. Communicating via phone and through an electronic medical record after patient encounters can help ensure that messaging remains clear and consistent between providers.

The dietitian and psychologist often review one another’s notes to evaluate changes in patient care and treatment goals. In this way, the psychologist can reinforce diet and nutrition-related goals set by the dietitian and the patient, and the dietitian can stay up to date on psychosocial interventions that the psychologist is utilizing and reiterate the importance of these practices to the patient.

Both providers should regularly check in with the patient about their perception of treatment, and continually monitor and adjust the treatment plan accordingly, including an eventual “graduation” from regular appointments with either or both providers.

In addition to coordination between the GI dietitian and GI psychologist, highly effective care includes regular communication and treatment planning with the entire team — the gastroenterologist, nursing staff, pharmacists, physical therapists and any other interdisciplinary providers — to ensure the patient’s specific needs and goals are being met.