Performing Department
(N/A)
Non Technical Summary
This produce presecription program (PPR) supports vulnerable cancer patients in achieving nutritional security during treatment and into survivorship. It meets the GusNIP purpose and priority through the following three primary goals:(1) to pilot and deliver a free produce prescription program for cancer patients and survivors who are at risk of nutritional insecurity while prioritizing inclusion and personal choice.(2) to provide evidence-based education on culinary medicine to complement the produce prescriptions.(3) To evaluate the produce prescription program and report required metrics to the GusNIP NTAE. The two-year project will serve up to 300 patients per year and dispense over 1500 fresh produce prescription bags customized for cancer patients. The project holds the promise of making a meaningful difference in connecting vulnerable patients to the foods needed to support their treatment and wellbeing while providing the knowledge and skills needed to maintain long-term nutritional security in the face of financial constraints made worse by cancer. Lessons learned through the project can be used to better integrate an awareness of food insecurity into oncology practice and ultimately reduce the financial burden that cancer places on patients and their families. Because the study builds on a robust culinary medicine program, findings can leverage food-as-medicine programs across the country to better address food insecurity. The study aligns with nation's strategic focus on precision nutrition. The findings will inform programs targeting other chronic diseases where secure access to nutrition can improve patient outcomes
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
The overall aim of the PPR is to support vulnerable cancer patients in achieving nutritional security during treatment and into survivorship. This project aligns both with USDA's strategic goal to "make safe, nutritious food available to all Americans" and the agency's priority to minimize the impact of diet-related chronic diseases through the food system, prioritizing inclusion, personalized food choices, data transparency, understanding, and impact. To align this project with the GusNIP purpose and priority, three specific goals are proposed:Goal 1. Pilot and deliver a free produce prescription program for cancer patients and survivors who are at risk of nutritional insecurity while prioritizing inclusion and personal choice.Goal 2. Provide evidence-based education on culinary medicine to complement the produce prescriptions.Goal 3. Evaluate the produce prescription program and report required metrics to the GusNIP NTAE.
Project Methods
Licensed clinical oncology social workers in the Winthrop P. Rockefeller Cancer Institute will verify eligibility for produce prescriptions during patient financial needs screening. UAMS healthcare professionals, namely, licensed clinical oncology social workers and dietitians, will write prescription referrals to patients verified as eligible, which will be filled on site in the Cancer Institute's Patient Support Pavilion.The prescription fulfilment model used here allows the study team to procure wholesale fruits and vegetables from UAMS's contracted food vendor, enabling on-premises assembly, customization of the produce prescription bags, and just-in-time delivery to assure that produce items are fresh. The study team will prioritize seasonal fruits and vegetables that are produced locally. Prioritizing fruits and vegetables that are in season locally will position the program to diversify procurement to include local food sourcing and support sustainability of this produce prescription program (PPR). Prescriptions will provide whole fresh fruit and will prioritize whole fresh vegetables of all types: dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables. The prescriptions will be designed to provide supplementation throughout the month. In addition to items with a shorter shelf life, prescriptions will include fresh produce items that can maintain physiological integrity between prescription fills.Prescriptions will align with the dietary guidance for the patient's condition and complement other nutritional supports the patient may be receiving through the Cancer Institute. Fresh fruits and vegetables will be appropriate to the patient's condition and support dietary guidance the patient is receiving from clinical dietitians in the Cancer Institute.A robust culinary-medicine-based educational component is integral to this PPR. Participants will receive instruction through appetizing, easy-to-use, recipes and gain experience on ways to make these foods an integral part of their diets, thereby setting the stage for longer-term nutritional security. Menus and recipes will incorporate produce items that are included in the prescription bags and that align with the health needs of patients. Given the financial challenges facing the target patient community, menus and recipes will be selected or modified to align with USDA's Thrifty Food Plan budget. The Thrifty Food Plan adheres to the Dietary Guidelines for Americans and is used to set SNAP benefit allotments. This ensures that knowledge acquired through the educational component of the project can be feasibly used by families participating in SNAP. Nutrition education will draw from the "The Health Meets Food" curriculum of the American College of Culinary Medicine, which reflects current research in diet and nutrition with efficacy supported by peer-reviewed studies.Delivery of the culinary-medicine education will be multimodal. Recipes and printed educational materials will be included in the produce prescription bags and made available online. Culinary medicine demonstrations will be conducted in a state-of-the art culinary medicine teaching kitchen located on campus and across the street from the Cancer Institute. Family members or friends who provide support to eligible patient will be encouraged to participate in the culinary medicine classes. Online and asynchronous access to the demonstrations will be available for those who cannot participate in person due to scheduling or health. Patients who are not eligible to participate in the produce prescriptions will also have online access to the educational materials and will be allowed participate in the in-person classes provided space is available.Project evaluation will include both process and outcome evaluations to assess effectiveness, impact, and reach of the PPR. Process evaluation will play an important role during all phases of the project but especially during the pilot phase (months 1-3). The study team will meet after each weekly prescription fulfillment cycle to identify what worked well and to identify improvements to assure that the PPR is reaching eligible participants and to identify barriers and facilitators of PPR activities.The outcome evaluation will address each of the required core participant metrics using the NTAE-recommended baseline and post surveys. Given the on-site distribution model, we propose a longitudinal design with the goal of assessing the core-patient metrics each time a produce prescription is filled. The advantages to this design are twofold. (1) It increases the likelihood of collecting at least one post-survey in the event a participant were to stop coming to UAMS for care and could no longer be contacted by the study team. (2) It provides repeated data necessary to assess dose/response associations in the core participant-level metrics and healthcare utilization and cost measures.The baseline and post surveys will be modified to include a short prescription order/refill form. The prescription order form will present a default prescription determined by study dietitians in consultation with healthcare providers but will allow the patient to change these defaults to accommodate their preferences and/or to reflect the recommendations of their oncology dietitian. Presenting the order/refill form along with the questions increases the likelihood that patients will complete the core-metric questions. During the pilot phase, the study team will evaluate the most effective way to address the post-surveys. For example, we may only include a rotating subset of the post-survey questions each time a prescription refilled in an effort to manage respondent burden, better accommodate self-reported measures of healthcare use and cost, while still collecting complete post prescription evaluation data over multiple prescription refills.Two strategies will be used to assess healthcare utilization and cost metrics. The first will include the 7-item self-reported healthcare utilization metrics developed for PPR projects by the GusNIP NTAE Center. The second will be to measure healthcare utilization and cost directly through claims data. Because of the sensitivity of claims data, our intention is to have a separate consent process that would allow patients to consent to participate in the self-reported core-participant metrics and healthcare utilization and cost measures without consenting to the use of their claims data. The study team will measure and report the required firm-level core metrics for clinic firms at the required intervals.Cost control and expansion will be a priority as the project progresses. The study team will initiate conversations with the Cancer Institute's Volunteer Services and Auxiliary about effective ways to incorporate volunteer support into the PPR. We will also focus on opportunities for student involvement through service-learning experiences. The study team should also have sufficient information on produce volumes to engage local agricultural producers as additional suppliers and support replication of the program in other clinical settings.