Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2017

Reliability of patient-led screening with the Malnutrition Screening Tool (MST):  agreement between patient and health professional scores in the cancer care ambulatory setting (#358)

Alexandra Di Bella 1 , Claire Blake 1 , Adrienne Young 1 , Anita Pelecanos 2 , Teresa Brown 1
  1. Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
  2. Statistics Unit, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia

Background:

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.

Objectives:

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.

Design:

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.

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 patient-MSTA and patient-MSTB (intra-rater reliability).

Results:

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%).

Conclusion:

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.