J Acad Nutr Diet. 2020 Jul;120(7):1210-1215. doi: 10.1016/j.jand.2019.10.015. Epub 2019 Dec 28.
The prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening.
The aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments.
DESIGN/PARTICIPANTS: A single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland.
The primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian.
Concurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient.
The ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found.
Patient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.
癌症患者营养不良的患病率高达 65%；然而，营养不良筛查往往不达标。营养不良筛查工具（MST）已被验证可由医护人员用于检测高危患者；然而，文献中存在一个空白，即患者主导的 MST 筛查的验证。
本研究旨在评估患者主导的 MST 与主观全面评估（SGA）的同时效度，以及在接受化疗或支持性治疗的门诊癌症护理服务的患者中，营养师主导的 MST 与患者主导的 MST 的观察者间信度。
设计/参与者：2017 年 5 月至 6 月，在澳大利亚昆士兰州一家大都市三级医院的门诊癌症护理环境中，对 201 名患者进行了一项单站点诊断准确性研究。
主要观察指标是患者（患者-MST）、营养师（营养师-MST）确定的 MST 评分以及营养师完成的 SGA 的同时效度和观察者间信度。
通过特异性、敏感性、阳性预测值和阴性预测值，确定患者主导的 MST 评分与 SGA 的同时效度。使用κ系数评估患者-MST 和营养师-MST 的观察者间信度。
发现患者主导的 MST 评分（0 至 1 与 2 至 5）指示营养状况的能力具有 94%（95%CI 81%至 99%）的敏感性、86%（95%CI 79%至 91%）的特异性和 0.93（95%CI 0.89 至 0.96）的受试者工作特征曲线下面积。阳性预测值为 59%（95%CI 45%至 71%），阴性预测值为 99%（95%CI 95%至 100%）。发现患者-MST 和营养师-MST 之间的加权κ值为 0.83（95%CI 0.82 至 0.87）。
患者主导的 MST 筛查是一种可靠且有效的措施，可以准确识别门诊癌症护理患者是否存在营养不良风险。
