CSSD Ethical Practices & Evidence-Based Guidelines 2 — Questions and Answers
Question 1: A CSSD is asked by a supplement company to endorse a product in exchange for payment. What is the most ethically appropriate response?
- Accept only if the payment is below $500
- Decline unless the product has strong peer-reviewed evidence supporting its claims (Correct answer)
- Accept and disclose the relationship in all endorsements
- Decline all supplement endorsements regardless of evidence
Correct answer: Decline unless the product has strong peer-reviewed evidence supporting its claims
CDR's Code of Ethics requires that RDs provide endorsements only for products they can support with credible evidence, and any financial relationships must be disclosed.
Question 2: Which study design provides the highest level of evidence when evaluating a nutrition intervention for athletic performance?
- Cross-sectional survey
- Case report
- Randomized controlled trial (Correct answer)
- Expert opinion
Correct answer: Randomized controlled trial
Randomized controlled trials sit at the top of the evidence hierarchy for evaluating causal effects of interventions.
Question 3: A college athlete discloses disordered eating patterns and asks the CSSD to keep it completely confidential from coaches and parents. The CSSD's ethical obligation is to:
- Honor the request fully, as confidentiality is absolute
- Immediately disclose to all parties without athlete consent
- Maintain confidentiality except when imminent harm risk exists, and discuss mandatory reporting limits upfront (Correct answer)
- Refer the athlete to another provider and share records automatically
Correct answer: Maintain confidentiality except when imminent harm risk exists, and discuss mandatory reporting limits upfront
Confidentiality is fundamental but has limits; practitioners should clarify these limits at intake and act when safety is at serious risk.
Question 4: The GRADE system used in evidence-based nutrition practice categorizes evidence quality primarily based on:
- Number of subjects enrolled in a study
- Study design, risk of bias, consistency, directness, and precision (Correct answer)
- Publication journal impact factor
- Whether the study was industry-funded
Correct answer: Study design, risk of bias, consistency, directness, and precision
GRADE evaluates multiple dimensions—not just sample size or funding—to assign evidence quality ratings from very low to high.
Question 5: A CSSD practicing in a state that does not license dietitians is approached by a client outside their usual scope. The best action is to:
- Provide services since there is no legal barrier
- Refer to a licensed professional with relevant credentials
- Consult CDR scope of practice guidelines and refer if outside competency (Correct answer)
- Decline all sports nutrition clients in unlicensed states
Correct answer: Consult CDR scope of practice guidelines and refer if outside competency
Even without state licensure requirements, the CSSD must practice within competency boundaries defined by CDR and refer when necessary.
Question 6: When a CSSD finds a conflict between a client's personal dietary beliefs and best available evidence, the ethical approach is to:
- Prescribe the evidence-based plan and require compliance
- Ignore the client's beliefs and focus solely on performance outcomes
- Respect autonomy while providing accurate evidence-based information to support shared decision-making (Correct answer)
- Defer entirely to the client's beliefs without offering evidence-based alternatives
Correct answer: Respect autonomy while providing accurate evidence-based information to support shared decision-making
Ethical practice balances respect for client autonomy with the obligation to provide accurate, evidence-based guidance.
Question 7: Which action best demonstrates the principle of 'non-maleficence' in sports nutrition practice?
- Recommending the most affordable supplement available
- Advising against a supplement with documented adverse effects even when a client requests it (Correct answer)
- Referring all supplement questions to team physicians
- Prioritizing performance outcomes over athlete health risks
Correct answer: Advising against a supplement with documented adverse effects even when a client requests it
Non-maleficence requires actively avoiding harm, including counseling against products with known risks despite client preference.
CSSD Ethical Practices & Evidence-Based Guidelines 2
A CSSD is asked by a supplement company to endorse a product in exchange for payment.
What is the most ethically appropriate response?