Implementation of an alternative menu to improve oral intake in patients with hematologic malignancies or undergoing bone marrow transplant at risk for malnutrition.

386 Background: Malnutrition is prevalent among patients with hematologic malignancies and those undergoing bone marrow transplant (BMT), and is linked to reduced treatment tolerance, poor treatment adherence, and diminished clinical outcomes. Moreover, treatment-related symptoms such as nausea, early satiety, and dysgeusia often reduce oral intake. This quality improvement project aimed to improve nutritional intake among hospitalized hematologic malignancy and BMT patients through an alternative menu designed for greater tolerability and appeal. Methods: From May 2024 to August 2024, patients on the Malignant Hematology and Bone Marrow Transplant Units who were at risk of malnutrition, defined as self-reported average meal completion of ≤50%, and had no food allergies or clinically indicated texture modifications were offered an alternative menu. The existing hospital menu was non-select, limiting patient autonomy and potentially contributing to poor intake. In contrast, the new menu was intentionally designed to be more tolerable and patient-directed, leveraging cold and room temperature foods—generally less odorous and better tolerated during treatment. High-protein, nutrient-dense options such as Greek yogurt, peanut butter, and hard-boiled eggs were prioritized. Foods known to exacerbate dysgeusia, such as red meat, were minimized. The menu provided an average of 2,486 calories and 93 grams of protein daily. Baseline intake was self-reported and a follow-up survey was conducted within 5–8 days. Results: Baseline average meal completion was 25.6%, representing an average of 512 calories and 23 grams of protein daily. At follow-up, average meal completion rose to 48.5%, constituting an 89% increase with an average intake of 1,206 calories and 45 grams of protein daily. Our initiative nearly doubled intake compared to pre-implementation levels, making adequate nutrition more attainable especially when paired with supplemental strategies like snacks and oral nutrition supplements. Patients also reported greater satisfaction and improved tolerance of the new menu options. Conclusions: This initiative demonstrated that a patient-directed, cold and room temperature menu significantly improved nutritional intake in patients with hematologic malignancies or undergoing BMT who are at high risk for malnutrition. The findings also highlight the limitations of a non-select menu model and suggest that offering patients greater choice and flexibility in meal selection—such as through room service-style models—may enhance nutritional outcomes. Because adequate nutrient intake is essential for improving clinical and functional outcomes, these strategies hold important implications for patient care. Further study is warranted to evaluate long-term impacts and scalability.