Our role statement defines the role of an APD when working in the area of cystic fibrosis.

The statement was developed by members of the Cystic Fibrosis Interest Group.

Knowledge

• Familiarity with the pathophysiology of cystic fibrosis, interdisciplinary management and nutrition co-morbidities (cystic fibrosis-related liver disease, CFRD, cystic fibrosis-related bones disease, distal intestinal obstruction syndrome, pancreatic insufficiency, pancreatitis, intestinal inflammation).
• Specific knowledge about pancreatic enzyme replacement therapy, including preparations available, mechanisms of action and dosing recommendations.
• Knowledge of pathophysiology of CFRD and evidence-based pathways for patients diagnosed with CFRD and abnormal glucose tolerance.
• Specific knowledge about the impact of CFTR modulator therapy on nutrition parameters.

Skills

• Ability to provide evidence based, specific and tailored nutrition advice to the individual with cystic fibrosis, considering the changing physiological and psychological needs related to disease state, treatment and life stage (adolescence, pregnancy, transplantation).
• Ability to provide nutrition education to people with cystic fibrosis-related diabetes (CFRD), using a variety of tools such as: food/blood glucose records, carbohydrate counting, glycaemic index, portion modelling, meal planning, label reading, cooking/recipe adjustments and behaviour modification.
• Interpretation of markers of nutrition status of individuals with cystic fibrosis (oral glucose tolerance tests, fat soluble vitamins, inflammatory markers, DEXA scans).
• Undertaking and interpreting body composition assessments, and indirect calorimetry (where facilities are available).
• Employ chronic condition management approaches to facilitate long-term management, including partnering with individuals with cystic fibrosis and their caregivers, goal setting and motivational interviewing.
• Ability to recognise the impact of cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy on nutrition recommendations and outcomes.

Activities entry level APDs would conduct 

• Complete the nutrition care process in collaboration with patient and multidisciplinary team to determine the individual energy, salt and fluid requirements based on factors such as lung function, pancreatic function, nutrition co-morbidities, anthropometric and body composition measurements, growth history, biochemical indices and physical activity.
• Communicate nutritional aspects of care with the individual with cystic fibrosis, their caregivers and the cystic fibrosis team to ensure continuity of care.
• Conduct regular nutritional surveillance of all individuals with cystic fibrosis attending their service, with all aspects of nutrition and gastrointestinal status being reviewed.
• Determine realistic goals for nutrition therapy in collaboration with the patient, their caregivers, and the cystic fibrosis team.
• Provide comprehensive advice to assist in maintaining an optimal weight and in the management of other cystic fibrosis co-morbidities.
• Seek support from a more experienced clinician about cystic fibrosis nutrition management.

Activities APDs working at a higher level would conduct 

• Overseeing the nutrition care of complex cases including end-stage lung disease, end-stage liver disease, renal disease.
• Provide individualised medical nutrition therapy for complex CFRD cases including poorly controlled and unstable blood glucose levels, potentially including insulin dose adjustment requirements where the APD has appropriate credentialing and mentoring with advanced scope of practice.
• Act as a nutrition resource person for the training, education and development and support of others involved in cystic fibrosis care e.g. mentoring/supervision of students or less experienced dietitians as well as various other health professionals.
• Lead nutrition and/or multi-professional quality improvement activities, research and/or audits. For example, implementing foodservice models of care for cystic fibrosis nutrition requirements.

Activities APDs working in this area do not usually undertake 

• Sole nutritional management of patients without the support of an interdisciplinary team.

For more, download the full role statement.