2.3. Intervention

The trial intervention was a multidisciplinary residential nutritional rehabilitation program with a primary focus on the physical, psychological, and social aspects of eating problems after treatment for HNC. The program comprised five-day initial residential stay and two-days follow-up residential stay after three months and consisted of group-based patient education sessions and a few individual activities. The program is based on REHPA’s and former Rehabilitation Centre Dallund’s core program developed through available evidence and more than 10 years’ experience in offering multidisciplinary residential rehabilitation programs for heterogeneous groups of cancer survivors [33,37,38]. The core model was further developed to meet the specific rehabilitation needs of HNC survivors through available evidence, patient involvement and a pilot study including 40 HNC survivors [4]. The program is described in further details in the trial protocol [24], and a schedule of activities during the residential stays is provided in Table 1.

Schedule for the initial five-day stay and two-day follow-up of the multidisciplinary residential nutritional rehabilitation program in the NUTRI-HAB trial.

Sessions specifically aimed at managing eating problems included a group session with a clinical dietitian on dietary advice, individual counselling with a clinical dietitian, a practical kitchen workshop with take-home recipes, a group session on oral hygiene and dental reimbursement rules, and instruction in swallowing exercises by an occupational therapist, who are typically responsible for dysphagia management in Denmark [39]. Participants received an exercise manual and a training diary and were encouraged to continue doing the exercises when they came home. During the residential stays, participants stayed at the premises, and all meals were served there. Foods of different flavors and textures were served to allow participants to experiment and to support their trial-and-error coping process as described in the introduction [4,6,20,21]. Physical activity sessions with physiotherapists included restorative yoga and sessions where participants were introduced to different kinds of physical activity that they could do at home, e.g., balance or resistance training exercises. Exercises were adjusted to the participants’ training level. Other activities included group sessions with a psychologist, a session on motivation and action plans, a group conversation with a priest on existence, massage therapy, and optional sessions on vocational counselling, fatigue, and sexuality and intimacy. Individual counselling sessions with relevant professionals (e.g., a speech pathologist or physician) were scheduled depending on the individual participant’s needs, assessed through patient-reported outcome measures. Between the initial stay and the two-day follow-up, all participants had two telephone consultations with a clinical dietitian scheduled in week 4 and week 8 to follow up on the individual consultation at the residential stay, to answer potential emerging questions, and to encourage the participant to continue with any activities or changes that they planned to implement after the residential stay.

Each scheduled program had a maximum capacity of 20 participants. The program was free of charge for participants.