Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 15, 2022
Date Accepted: Sep 23, 2022
A digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment in hospitalized patients with cancer: Evaluation and diagnostic accuracy of R+ Dietitian
ABSTRACT
Background:
Malnutrition is a common problem in patients with cancer that increases the risk of mortality. Early and timely screening in patients with cancer who are nutritionally at risk is crucial for improving clinical outcomes. Dietary assessment is also important to guide precise and individual nutritional planning after nutritional screening. A self-screening tool built into a smartphone might represent an easier and effective modality for increasing the screening rate of malnutrition and the efficiency of dietary assessment based on the popularity of smartphones in China.
Objective:
This study aims to validate a WeChat-based digital self-ministered tool for nutritional risk screening and dietary energy and protein assessment in patients with cancer.
Methods:
We conducted a prospective diagnostic test accuracy study in patients with cancer in Chengdu, China. In total, 244 patients with a median (interquartile range) age of 59 (51–68) years were recruited to use the WeChat-based digital self-administered tool R+ Dietitian (includes three parts, RDNRS2002, RDabPG-SGA, and RDDA) for nutritional risk screening and undergo assessments of dietary energy and protein intake. Nutritional risk screening (NRS 2002), abridged scored Patient-Generated Subjective Global Assessment (abPG-SGA), and 24-h dietary recall for 3 days (3d-24HRs) were performed by dietitians as reference tests. Sensitivity; specificity; positive predictive value (PPV); negative predictive value (NPV); kappa value; and the correlation coefficients of RDNRS2002, RDabPG-SGA, and RDDA were analyzed to validate R+ Dietitian.
Results:
All participants completed R+ Dietitian, NRS2002, and abPG-SGA, and 214 (87.7%) patients finished 3d-24HRs. Both RDNRS2002 (sensitivity = 84.5%, 95% confidence interval [CI] = 72.1–92.2; specificity = 64.5%, 95% CI = 57.1–71.3) and RDabPG-SGA (sensitivity = 81.0%, 95% CI = 65.4–90.9; specificity = 76.7%, 95% CI = 70.2–82.2) were rated as having fair validity because their sensitivity exceeded 50% and their specificity was lower than 80%. In addition, fair agreement with NRS2002 and abPG-SGA conducted by dietitians was observed with correlation coefficients of 0.62 (95% CI = 0.54–0.70, P<.001) and 0.56 (95% CI = 0.47–0.64, P<.001), respectively. The kappa values for RDNRS2002 and RDabPG-SGA were 0.42 (95% CI = 0.30–0.54, P<.001) and 0.37 (95% CI = 0.26–0.47, P<.001), respectively. Compared to the findings for RDNRS2002, RDabPG-SGA had a slightly higher PPV (42.6% [95% CI = 33.5–52.2] vs. 42.0% [95% CI = 31.3–53.5]) and lower NPV (93.0% [95% CI = 86.6–96.6] vs. 95.1% [95% CI = 90.2–97.7]). RDDA displayed a moderate correlation with 3d-24HRs (correlation coefficients for energy and protein intake were 0.59 [95% CI = 0.49–0.67] and 0.47 [95% CI = 0.36–0.57], respectively, both P<.001).
Conclusions:
R+ Dietitian is a fairly valid instrument for nutritional risk screening and dietary energy and protein intake assessment. Clinical Trial: ChiCTR1900026324
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