Food Protection Trends - September/October 2022 - 397

diet and that patient noncompliance was a potential problem
(2, 17, 18). As time went by, the sterile diet became more
liberalized, allowing for the emergence of what is known today
as a neutropenic diet. In some studies, the neutropenic diet was
sometimes referred to as a " low-bacteria diet, " " low-microbial
diet, " and " reduced bacteria diet " (28). The neutropenic diet
focuses on placing restrictions on certain food items. However,
a few studies have compared a neutropenic diet to a regular diet
while examining the rate of infection in patients and reported
no significant evidence to justify prescribing the neutropenic
diet (12). In addition, the neutropenic diet restrictions vary
among institutions and even among providers in the same
institution (4). Besides the ineffectiveness and inconsistency,
the neutropenic diet may lead to nutrient deficiencies and
patient dissatisfaction due to a lack of variety in the diet (22).
Therefore, some institutions who made the transition from the
neutropenic diet to safe food handling approach have proven
practicing food safety and proper food handling are effective in
preventing infection among patients (9, 25), while others are
hesitant to make the change. The safe food handling approach
focuses on four steps of food safety, " clean, " " separate, " " cook, "
and " chill, " when handling food, detailed in the Food Safety
for Older Adults and People with Cancer, Diabetes, HIV/AIDS,
Organ Transplants, and Autoimmune Diseases booklet of the U.S.
Food and Drug Administration (FDA) (26).
Physicians are considered the most credible source of information
about health in the United States (31). However, several
studies have reported inconsistencies in their opinions regarding
prescribing practices and documentation (8, 19, 24). Cook et
al. (6) reported that the healthcare providers expressed a clear
need for information related to food safety during pregnancy
and listeriosis, as supported by their lack of knowledge in these
areas. Wohlgenant et al. (29) conducted a focus group study
and revealed healthcare providers lack training, knowledge, and
willingness to provide food safety information to older adults.
Therefore, campaigns about food safety education targeted for
doctors have been recommended (30).
There has been little research examining the health providers
who treat cancer patients prescribing the neutropenic diet or
attitudes on replacing it with a safe food handling approach.
A semistructured interview was conducted to answer the
following three questions:
(i) What do oncology providers know about the
neutropenic diet?
(ii) What beliefs and attitudes do oncology providers have
regarding the neutropenic diet?
(iii) How do oncology providers feel about implementing
a safe food handling guideline in replacement of the
neutropenic diet?
METHODS
Ethical consideration of study
The study presents minimal to no risk for participants,
and data were deidentified to protect confidentiality and
September/October Food Protection Trends 397
anonymity. If mentioned, identifying information, such as
names and workplace, were redacted from the transcriptions,
and each participant was assigned a researcher-generated
identification number. All participants were provided with
a letter of informed consent that noted the purpose of the
study, the procedure that would be done, the potential
risks and benefits of the study, and how the data would be
handled, stored, and discarded. Every participant provided
verbal consent prior to data collection, and a signed letter
of consent was obtained from every participant for proper
documentation. This research study was reviewed and
approved by the Louisiana State University AgCenter (HE2017)
and Franciscan Missionaries of Our Lady University
Institutional Review Board (2020-071) to ensure ethical
compliance and protection of human subjects.
Interview question design
Semi-structured interviews were conducted to collect data
from healthcare professionals. The interview guide, Healthcare
Professionals Overseeing Immunocompromised Patients and
the Neutropenic Diet, consisted of six questions (Table 1).
A draft interview instrument was distributed to five content
experts, and feedback was gathered through email comments,
as well as through in-person discussion.
Participant recruitment and selection
To begin the recruitment process, the researcher identified
potential study participants by searching on healthcare
facilities' websites in Louisiana and Mississippi. Oncology
providers who met the study criteria were sent a recruitment
email. Subsequent recruitment efforts involved calling potential
participants or recruiting participants in person. Each potential
provider was asked to participate in the study through
an interview or written survey. To be included in the study, all
participants were to complete and return a letter of informed
consent that detailed the objective and purpose of the study.
The research team sought to obtain 20 provider interviews
for a broad overview of the beliefs of oncology providers.
Although not made known to the participants during the recruitment
process, all participants received financial compensation
upon completion of the study. A total of 91 invitations
were distributed, with a response rate of 9.89%.
Purposive sampling was used to select the study participants.
All providers who responded to the recruitment efforts
of the researcher and met the inclusion criteria of the study
were selected. Inclusion criteria included participants being
an active medical oncology physician, nurse practitioner,
or physician assistant and practicing in the United States.
Oncology providers who specialized in radiation or surgery,
as well as retired providers, or providers practicing outside of
the United States were excluded from the study.
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