Malnutrition prevalence in cancer patients is reported as high as 80%, and is associated with lower survival, reduced response to treatment and poorer performance status. The Malnutrition Screening Tool (MST) is a validated tool when administered by a health professional; however, has not been validated for patient-led screening.
This study aims to validate patient-led MST screening though assessing inter-rater reliability between patient and dietitian-researcher led screening and intra-rater reliability between an initial and repeat patient screening.
Cross-sectional. Participants: 208 adults attending ambulatory cancer care services in a metropolitan teaching hospital in Queensland, Australia (n=160 inter-rater reliability; n=48 intra-rater reliability using a separate sample).
Main outcome measurements:
MST risk categories (MST 0-1: not at risk, MST ≥2: at risk) as determined by screening completed by patients and dietitian-researcher, and patient test-retest screening; patient acceptability.
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 patient-MSTA and patient-MSTB (intra-rater reliability).
High inter-rater reliability and intra-rater reliability was observed. Percent agreement between patient-MST and dietitian-MST was 96%, with “almost perfect” chance adjusted agreement (κ = 0.92, 95% CI 0.84 – 0.97, P<0.001). Percent agreement between repeated patient-MSTA and patient-MSTB was 94%, with “almost perfect” chance-adjusted agreement (κ = 0.88, 95% CI 0.71 – 1.00, P<0.001). Based on dietitian-MST, 32% (n=53) were identified at risk of 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 easy to understand (95%) and took <5 minutes to complete (99%).
Patient-led MST screening is reliable in this setting and well-accepted by patients. Patient-led screening in the cancer care ambulatory setting has potential to improve patient autonomy in their care and screening completion rates.