Dissertations and Theses
Date of Degree
6-2-2026
Document Type
Dissertation
Degree Name
Doctor of Public Health (DPH)
Department
Community Health and Social Sciences
Advisor(s)
Emma Tsui
Committee Members
Ghada Soliman
Nicholas Grosskopf
Subject Categories
Dietetics and Clinical Nutrition | Nutrition | Public Health
Keywords
Food Insecurity, Dietitian, Nutritionist, Cancer, Scoping Review, NASEM, Health Care Providers
Abstract
Abstract
Objective
Food insecurity screening and referrals in acute care remain early in development, highly variable across institutions, and marked by limited dietitian involvement. The objective of this three-part study was to examine food insecurity screening and referral practices in acute care settings, explore dietitians’ perspectives and experiences with screening in oncology care, and incorporate stakeholder insights to inform organizational and programmatic recommendations aligned with national guidance to strengthen food insecurity interventions.
Methods
To inform oncology‑specific, multilevel improvements, we conducted a scoping review (PubMed, Scopus, CINAHL; 28 studies) to assess current food insecurity screening and referral practices in acute care and identify the roles of health care providers (HCPs), particularly dietitians. Qualitative semi-structured in-depth interviews conducted with clinical dietitians (n=17; Fall 2021) at a private oncology center in New York City in Aim 2 explored perceptions, barriers, facilitators, and resource needs related to screening and referrals. Aim 3 used semi-structured in-depth interviews with key stakeholders (n=19; Summer–Winter 2024) at the same institution, including hospital administrators, nurses, social workers, physicians, and patient relations staff. Data were analyzed using codebook thematic analysis in Aim 2 and a modified Framework Method approach in Aim 3. All aims informed practice recommendations.
Results
The literature from the scoping review highlighted facilitators – such as integration with Electronic Health Record (EHR), adequate staffing, community partnerships, and regulatory alignment) and barriers (heterogeneous structures and processes). Dietitian interviews identified programmatic and structural constraints; discomfort with screening driven by beliefs and assumptions; and time, training, and resource limitations. Dietitians also described leveraging counseling skills to navigate emotionally charged conversations, underscoring their unique suitability to lead screening and referrals. Stakeholder interviews illuminated organizational culture around social drivers of health, programmatic barriers, constrained hospital resources, and perceived patient stigma, while recommending EHR‑enabled workflows, targeted education and training, streamlined referral pathways, increased access to community resources, and stronger dietitian participation.
Discussion/Implications
Synthesizing findings across aims, we propose actionable recommendations aligned with National Academies of Sciences, Engineering, and Medicine (NASEM) guidance, including embedding validated screening tools in EHR, clarifying roles and accountability, building staff capacity to address both technical processes and interpersonal communication, strengthening community partnerships, and instituting governance for sustainability and evaluation. Given that cancer transcends socioeconomic status, addressing food insecurity is integral to quality oncology care; implementing these recommendations can enhance the feasibility, fidelity, and equity of screening and referral programs in cancer settings.
Recommended Citation
Peets, Tatanisha K., "Food Insecurity in Acute Cancer Care" (2026). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/133
