Passion for helping patients often drives innovation. Laura Kerns, a registered dietitian and certified specialist in oncology nutrition, is a prime example. In recent years, Laura has worked to streamline the way feeding tubes are placed, maintained and removed for head and neck cancer patients.
The model she created with her colleagues plays a major role in lowering infection and complication rates and has improved the overall patient experience. The model has been recognized around the country and the world, and adopted by other hospital systems.
This interview shines the spotlight on Laura and her drive to help patients who use feeding tubes.
Q: As a dietitian, what role do you play when it comes to tube feeding?
Laura Kerns: Where I work, I have a very active role with my patients, and I advocate for other dietitians to do the same. I enjoy encouraging students, interns and practicing dietitians to have a larger role in tube feeding care and education. Dietitians are already the food experts, so it also makes sense for us to be the “tube experts.”
I educate my patients before a feeding tube is placed so they know what to expect from the process and have a basic idea of how to use the tube. After placing the tube, I provide hands-on education and schedule deliveries for supplies. How often I follow up depends on why the feeding tube was placed. I see radiation oncology patients every week, but with surgical patients it may be every two to four weeks based on their comfort level with their tube feeds.
Q: What clinicians do you work with?
Laura Kerns: Working in oncology takes a big team. I’m blessed to work with a very supportive group of doctors, advanced practice providers, nurses, pharmacists, social workers, radiation therapists, medical assistants, financial and clinical coordinators, administrators, schedulers and patient access representatives.
Q: Who are the patients you work with most often?
Laura Kerns: I only work with adult cancer patients. It can be at any point in their journey — from newly diagnosed through survivorship.
Q: Do you work with all patients who come through your facility and office?
Laura Kerns: I don’t work with every patient because there are thousands of them at our facility. However, we offer nutrition services to any patient who asks for them.
Q: Why should a patient think about working with a dietitian?
Laura Kerns: For patients with feeding tubes, I’ve found that it really helps to have one “point person” who can help address problems and answer questions. Dietitians are also able to help walk patients through all the different choices in formulas and adjust formulas quickly if they’re not working. If you choose to blenderize your meals, it’s vital to work with a dietitian, especially at the beginning. That way, you can make sure your foods have the nutrition you need.
Q: How would someone go about getting connected with a dietitian?
Laura Kerns: If you’re already in a hospital network, you can usually get a referral from your doctor. You can also find a dietitian near you by using the Academy of Nutrition and Dietetics Find an Expert search feature.
Q: What type of nutrition do you prescribe? Is it formula, commercial or homemade blenderized diets, or both?
Laura Kerns: It depends on the person, their goals and their comfort level. Some people are most comfortable with commercial formulas that are easy and handy. Others would rather make their own food, so they know what’s in it. There are always other factors at play as well. These may include cost, insurance coverage, equipment and how well the patient tolerates the tube feeds.
Most of my patients want formulas that are covered by insurance. But many of them will add blenderized foods to their diets along with the formula.
Q: What are the benefits of these different types of nutrition?
Laura Kerns: Formulas are usually safe and convenient, and they provide all the essential nutrients. Blenderized meals take a lot more effort, but they’re real food that your body is used to. This can be easier to tolerate, help the tube-feeding method feel more normal, and allow for more normal digestion.
Q: How does the age or health of a patient help you decide what diet to prescribe?
Laura Kerns: I usually start everyone on a commercial formula until they’re used to having a tube. Patients who stay with commercial products often have complex health histories or will only need their tubes for a short time. Long-term tube feeders with good support systems and the right living situations can transition to blenderized diets or a combination.
If I worked with children or adolescents, I would likely advise more blenderized feedings earlier in the process.
Q: What education or resources do you offer your patients?
Laura Kerns: I find hands-on education and teaching back are the most effective. Teaching back means I have the patient explain the process to me to show they understand what I’m saying. Patients also receive detailed handouts that also reinforce what they learn. I will also point patients to online resources and YouTube videos from trusted sources.
Q: What advice would you give people who aren’t working with a dietitian that would help them find the nutrition that’s right for them or their loved one?
Laura Kerns: First, I would say find a dietitian to work with, but that’s my biased opinion! Many infusion companies that provide tube feeding supplies work with dietitians and may easily be able to connect you to one. Support groups with people that have the same health condition can be helpful.
Q: Any other tips or tricks about working with a dietitian, nutrition, etc. that you’d like to share?
Laura Kerns: The more information you give a dietitian, the better. If you have questions or aren’t sure about something, please ask! Often patients are embarrassed to talk about bowel movements or other digestive issues, but that is what we’re here for and trained to help with!