Graduation Semester and Year
Summer 2026
Document Type
DNP Project
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Dr. Tiffany Trent
Abstract
Introduction/Background
Malnutrition affects approximately 43% of cancer patients nationally and is associated with missed chemotherapy appointments, treatment interruption, and poor clinical outcomes. At a 30-chair outpatient cancer center in South Texas, a retrospective chart review revealed that 45% of patients experienced malnutrition-related symptoms contributing to appointment disruptions. Despite evidence-based recommendations for routine nutritional screening and support, no standardized protocol existed at this site.
Objectives
The purpose of this quality improvement project was to implement a nurse-led nutritional support protocol and evaluate its effectiveness in (1) reducing the missed chemotherapy appointment rate from 10% to 5%, (2) achieving 100% compliance with the malnutrition screening using the Malnutrition Screening Tool (MST), and (3) maintaining patients’ body weight within + 5 pounds, body mass index (BMI) within + 1 unit, and serum albumin levels within normal range (3.5-5.0g/dL) over 8 weeks.
Methods
Using the Plan-Do-Study-Act framework, a nurse-led nutritional support protocol was implemented for the adult chemotherapy patients aged 18 years and older. The protocol included MST screening at each visit, monitoring weight, BMI, and serum albumin levels, and administration of oral nutritional supplements (ONS), and chemotherapy-specific dietary education for patients scoring > 2 on the MST. Data from 462 encounters were analyzed using descriptive statistics with frequency analysis and McNemar Tests.
Finding
MST screening compliance reached 100%, with 14.5% of encounters (n = 67) identified as at nutritional risk. The missed chemotherapy appointment rate decreased from 10% to 8%, a 20% relative reduction. McNemar tests demonstrated statistically significant associations between nutritional interventions and chemotherapy receipt for both ONS (χ² = 343.603, p < .001) and dietary education (χ² = 298.301, p < .001). Mean BMI (31.44 ± 7.54) and serum albumin (3.66 ±0.48 g/dL) were maintained within acceptable parameters.
Conclusions
A nurse-led nutritional support protocol incorporating MST screening, ONS, and dietaryeducation was effective in reducing missed chemotherapy appointments and maintaining nutritional indicators. The protocol is sustainable, cost-effective, and adaptable for other outpatient oncology settings.
Keywords
malnutrition, chemotherapy, nutritional screening, nurse-led intervention, quality improvement, oral supplements, oncology nursing.
Disciplines
Dietetics and Clinical Nutrition | Other Nursing | Public Health and Community Nursing
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Balboa, Eva, "A Quality Improvement Project: Nurse-Led Nutritional Support to Reduce Missed Chemotherapy Appointments" (2026). Doctor of Nursing Practice (DNP) Scholarly Projects. 4.
https://mavmatrix.uta.edu/nursing_dnpprojects2/4
Included in
Dietetics and Clinical Nutrition Commons, Other Nursing Commons, Public Health and Community Nursing Commons