J Acad Nutr Diet. 2018 Jun;118(6):1065-1071. doi: 10.1016/j.jand.2017.11.023. Epub 2018 Feb 15.
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.
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).
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.
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).
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%).
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.
癌症患者的营养不良患病率高达 60%至 80%，营养不良与生存率降低、治疗反应降低和功能状态较差有关。营养不良筛查工具（MST）在由医疗保健专业人员进行管理时是一种经过验证的工具；然而，尚未对其进行患者主导的筛查评估。
本研究旨在通过评估患者主导的 MST 筛查与营养师研究人员主导的筛查之间的评分者间可靠性以及初始和重复患者筛查之间的评分者内可靠性，来评估患者主导的 MST 筛查的可靠性。
设计/参与者：这项横断面研究纳入了 2016 年 10 月在澳大利亚昆士兰州一家都市教学医院的门诊癌症护理服务中接受治疗的 208 名成年人（评分者间可靠性为 160 例，评分者内可靠性在单独样本中测量了 48 例）。
主要结局测量指标为患者和营养师研究人员完成的 MST 筛查确定的 MST 风险类别（MST0-1：无风险，MST≥2：有风险）、患者的测试-重测筛查以及患者的可接受性。
百分比和机会校正一致性（Cohen's kappa 系数，κ）用于确定患者-MST 和营养师-MST（评分者间可靠性）之间的一致性，以及患者入院时完成的 MST（患者-MSTA）和患者初始 MST 完成后 1 至 3 小时完成的 MST（患者-MSTB）（评分者内可靠性）之间的一致性。
观察到高评分者间可靠性和评分者内可靠性。患者-MST 和营养师-MST 之间的一致性为 96%，具有“几乎完美”的机会调整一致性（κ=0.92，95%置信区间 0.84 至 0.97）。重复的患者-MSTA 和患者-MSTB 之间的一致性为 94%，具有“几乎完美”的机会调整一致性（κ=0.88，95%置信区间 0.71 至 1.00）。根据营养师-MST，33%（n=53）的患者被确定为存在营养不良风险，其中 40%的患者表示未见到营养师。在提供反馈的 156 名患者中，几乎所有患者都报告 MST 很清楚（92%），问题易于理解（95%），且完成时间≤5 分钟（99%）。
使用 MST 进行患者主导的筛查是可靠的，并且患者易于接受。在癌症护理门诊环境中进行患者主导的筛查，有可能提高患者的自主权和筛查完成率。
