{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:45:42Z","timestamp":1790934342088,"version":"4.1.0"},"reference-count":58,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Transdisciplinary Integrated Population Science Pilot Grants Program, Thomas Jefferson University\u2019s Sidney Kimmel Cancer Center"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cancer Control"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study explored perceptions of barriers and facilitators to healthful dietary behaviors among patients with gastrointestinal (GI) cancer and their caregivers, including caregiver preparedness, patient and caregiver self-efficacy for symptom management, and other environmental, social, and familial factors that may serve as barriers and facilitators to healthful eating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a concurrent mixed methods cross-sectional study design, individuals with GI cancer receiving outpatient chemotherapy and their caregivers completed surveys, dietary assessments, and interviews. Caregiving preparedness, self-efficacy for symptom management, and dietary intake were assessed using validated instruments. Dietary quality was measured using the Healthy Eating Index (HEI)-2020. In-depth interviews explored barriers and facilitators to healthful eating, symptom management, and caregiver preparedness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-seven patient-caregiver dyads completed study activities (N = 54). Dietary quality scores ranged from 26 to 81, with a median score of 43 for patients and 42 for caregivers. Thematic analysis identified three barriers to healthful eating: caregiver self-efficacy and preparedness, caregiver needs are neglected, and nutrition as a source of conflict. Overall self-efficacy scores (Mdn, [IQR]) were 69.1 (45.0) for caregivers and 75.6 (34.1) for patients. Caregiver preparedness score was 2.99 \u00b1 .87; problem areas were identified, including addressing emotional needs, fluctuating eating habits, advanced disease progression and making care activities pleasant. Despite the challenges, three main facilitators were identified: increased awareness and value of nutrition, influential others, and positive coping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest the importance of developing interventions that increase nutrition-related preparedness among caregivers and self-efficacy for managing treatment side effects. Future research should continue to explore the relationship between positive coping and dietary behaviors. While engaging patients and caregivers together during dietary interventions is a promising modality, strategies for maintaining personal nutrition-related goals when facing contrasting priorities between patients and caregivers should be addressed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748231208316","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:04:15Z","timestamp":1698883455000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["<i>\u201cKeep Your Chin Up, and Keep Eating\u201d:<\/i>\n                    Perceptions of Barriers and Facilitators to Healthful Dietary Behaviors Among Individuals With Gastrointestinal Cancer and Caregivers"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1113-9043","authenticated-orcid":false,"given":"Brandy-Joe","family":"Milliron","sequence":"first","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia","family":"Klobodu","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Deutsch","sequence":"additional","affiliation":[{"name":"Department of Food and Hospitality Management, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karon","family":"Martyn","sequence":"additional","affiliation":[{"name":"Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Dychtwald","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Riahi","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn","family":"Carro","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Hisek","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Darcy","sequence":"additional","affiliation":[{"name":"Asplundh Cancer Pavilion, Sidney Kimmel Cancer Center, Jefferson Health, Willow Grove, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann C","family":"Klassen","sequence":"additional","affiliation":[{"name":"Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,11,1]]},"reference":[{"key":"bibr1-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.31937"},{"key":"bibr2-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2020.02.068"},{"key":"bibr3-10732748231208316","unstructured":"GI Cancers Alliance. Gastrointestinal cancer by the numbers. 2022. Available from: gicancersalliance.org."},{"key":"bibr4-10732748231208316","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21440"},{"key":"bibr5-10732748231208316","volume-title":"Diet, Nutrition, Physical Activity, and Cancer: A Global Perspective. A Summary of the Third Expert Report","author":"World Cancer Research Fund\/American Institute for Cancer Research","year":"2018"},{"key":"bibr6-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33326-3"},{"key":"bibr7-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30456-5"},{"key":"bibr8-10732748231208316","doi-asserted-by":"publisher","DOI":"10.3390\/nu14020356"},{"key":"bibr9-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1177\/0148607113502674"},{"key":"bibr10-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/S1040-8428(00)00048-2"},{"key":"bibr11-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1054\/clnu.2002.0540"},{"key":"bibr12-10732748231208316","unstructured":"American Cancer Society. Caregivers and Family: what a cancer caregiver does. 2016. Available from. https:\/\/www.cancer.org\/treatment\/caregivers\/what-a-caregiver-does.html"},{"key":"bibr13-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-012-1575-8"},{"key":"bibr14-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2817-3"},{"key":"bibr15-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05386-0"},{"key":"bibr16-10732748231208316","author":"Packel L","year":"2022","journal-title":"Rehabilitation Oncology"},{"key":"bibr17-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05951-7"},{"key":"bibr18-10732748231208316","volume-title":"A Concise Introduction to Mixed Methods Research","author":"Creswell JW","year":"2015","edition":"1"},{"key":"bibr19-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"bibr20-10732748231208316","unstructured":"Hunt GG, Longacre ML, Kent EE, et al. Cancer caregiving in the U.S. An intense, episodic, and challenging care experience. National alliance for caregiving in partnership with the national cancer institute and the cancer support community. 2016."},{"issue":"6","key":"bibr21-10732748231208316","first-page":"114523","volume":"292","author":"Hennick M","year":"2021","journal-title":"Soc Sci Med"},{"key":"bibr22-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1188\/18.ONF.342-353"},{"key":"bibr23-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.09.010"},{"key":"bibr24-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2005.06.021"},{"key":"bibr25-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2004.02.020"},{"key":"bibr26-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(02)00448-7"},{"key":"bibr27-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2797-3"},{"key":"bibr28-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1002\/nur.4770130605"},{"key":"bibr29-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1002\/mds.870130108"},{"key":"bibr30-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2003.10.010"},{"key":"bibr31-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.07.010"},{"key":"bibr32-10732748231208316","unstructured":"U.S. Department of Agriculture, Food and Nutrition Service, Center for Nutrition Policy and Promotion. Average healthy eating index-2015 scores for adults by age groups. What We Eat in America NHANES 2017-2018; 2021. Available from: https:\/\/fns-prod.azureedge.us\/sites\/default\/files\/media\/file\/HEI-2015_Adults_NHANES2017-2018.pdf"},{"key":"bibr33-10732748231208316","doi-asserted-by":"publisher","DOI":"10.3390\/nu13082717"},{"key":"bibr34-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2018.05.021"},{"key":"bibr35-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12117"},{"key":"bibr36-10732748231208316","first-page":"75","volume":"29","author":"Guba EG","year":"1981","journal-title":"Educ Technol Res Dev"},{"key":"bibr37-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jand.2020.08.086"},{"key":"bibr38-10732748231208316","doi-asserted-by":"publisher","DOI":"10.3390\/nu10040452"},{"key":"bibr39-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1177\/1049732312443739"},{"key":"bibr40-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1092-1"},{"key":"bibr41-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29223"},{"key":"bibr42-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-018-0346-9"},{"key":"bibr43-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-018-4590-6"},{"key":"bibr44-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.10.016"},{"key":"bibr45-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-020-05811-4"},{"key":"bibr46-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1188\/20.ONF.692-702"},{"key":"bibr47-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1080\/10253890.2022.2037548"},{"key":"bibr48-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2296-15-81"},{"key":"bibr49-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12357"},{"key":"bibr50-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1111\/jnu.12496"},{"key":"bibr51-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s10880-015-9416-9"},{"key":"bibr52-10732748231208316","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2019.00208"},{"key":"bibr53-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2021.102079"},{"key":"bibr54-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-013-1807-6"},{"key":"bibr55-10732748231208316","doi-asserted-by":"publisher","DOI":"10.12659\/MSM.907730"},{"key":"bibr56-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06265-y"},{"key":"bibr57-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1177\/1090198117705164"},{"key":"bibr58-10732748231208316","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2018.08.011"}],"container-title":["Cancer Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748231208316","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10732748231208316","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748231208316","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T14:23:48Z","timestamp":1777386228000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10732748231208316"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":58,"alternative-id":["10.1177\/10732748231208316"],"URL":"https:\/\/doi.org\/10.1177\/10732748231208316","relation":{"has-review":[{"id-type":"doi","id":"10.1177\/10732748231208316\/v2\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v3\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v1\/review2","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v3\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v1\/review1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v2\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v2\/response1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v1\/decision1","asserted-by":"object"},{"id-type":"doi","id":"10.1177\/10732748231208316\/v3\/decision1","asserted-by":"object"}]},"ISSN":["1073-2748","1526-2359"],"issn-type":[{"value":"1073-2748","type":"print"},{"value":"1526-2359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]},"article-number":"10732748231208316"}}