Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting

Published:February 15, 2018DOI:https://doi.org/10.1016/j.jand.2017.11.023

      Abstract

      Background

      The prevalence of malnutrition in patients with cancer is reported as high as 60% to 80%, and malnutrition is associated with lower survival, reduced response to treatment, and poorer functional status. The Malnutrition Screening Tool (MST) is a validated tool when administered by health care professionals; however, it has not been evaluated for patient-led screening.

      Objectives

      This study aims to assess the reliability of patient-led MST screening through assessment of inter-rater reliability between patient-led and dietitian-researcher–led screening and intra-rater reliability between an initial and a repeat patient screening.

      Design/participants

      This cross-sectional study included 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia, in October 2016 (n=160 inter-rater reliability; n=48 intra-rater reliability measured in a separate sample).

      Main outcome measurements

      Primary outcome measures were MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and a dietitian-researcher, patient test–retest screening, and patient acceptability.

      Statistical analysis

      Percent and chance-corrected agreement (Cohen’s kappa coefficient, κ) were used to determine agreement between patient-MST and dietitian-MST (inter-rater reliability) and MST completed by patient on admission to unit (patient-MSTA) and MST completed by patient 1 to 3 hours after completion of initial MST (patient-MSTB) (intra-rater reliability).

      Results

      High inter-rater reliability and intra-rater reliability were observed. Agreement between patient-MST and dietitian-MST was 96%, with “almost perfect” chance-adjusted agreement (κ=0.92, 95% CI 0.84 to 0.97). Agreement between repeated patient-MSTA and patient-MSTB was 94%, with “almost perfect” chance-adjusted agreement (κ=0.88, 95% CI 0.71 to 1.00). Based on dietitian-MST, 33% (n=53) of patients were identified as being at risk for malnutrition, and 40% of these reported not seeing a dietitian. Of 156 patients who provided feedback, almost all reported that the MST was clear (92%), questions were easy to understand (95%), and completion time was ≤5 minutes (99%).

      Conclusion

      Patient-led screening with the MST is reliable and well accepted by patients. Patient-led screening in the cancer care ambulatory setting has the potential to improve patient autonomy and screening completion rates.

      Keywords

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      Biography

      A. Di Bella is an accredited practising dietitian, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

      Biography

      C. Blake is an accredited practising dietitian, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

      Biography

      A. Young is an accredited practising dietitian, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

      Biography

      T. Brown is an advanced accredited practising dietitian, Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia.

      Biography

      A. Pelecanos is a biostatistician, Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.