Background
Evidence-based guidelines recommend malnutrition screening is conducted regularly for all oncology patients. Local quality improvement audits found ~70% adherence to screening. Barriers to screening were identified including clinician time pressures, competing priorities, inadequate training and perceptions of professional judgement being adequate. A digital, patient-led innovation was hypothesised to overcome these barriers, improve screening rates and reduce clinician burden.
Methodology
Over five phases, spanning the past decade, clinical evidence was progressively established including: audits of clinical practice; cross-sectional reliability study (n=208); validity study (n=201); implementation of the digital patient-led malnutrition screening tool (MST) using an implementation science framework (i-PARIHS); a multi-phase prospective sustainability study; and a scale and spread project using the Mi-PARIHS implementation science framework, extending the digital innovation to all cancer care services. Consumer and multidisciplinary co-design produced the digital MST delivered via SMS to patients' mobile devices.
Results
The patient-led MST demonstrated almost perfect inter-rater reliability against dietitian-led screening (96% agreement; κ=0.92) and intra-rater reliability (94%; κ=0.88), with high patient acceptability, and high sensitivity (94%) and specificity (86%) against the Subjective Global Assessment (SGA). Post-implementation, uptake of the digital screening tool was 70%, with 50% of self-referrals being for reasons other than the malnutrition risk score, including symptom management, general nutrition advice, and survivorship. This increased dietetic activity by 192%. Patient engagement with the digital innovation was sustained at 4 years post-implementation (69%). Scale and spread of the innovation to include radiation oncology outpatients was successfully accomplished, with three-month evaluation scheduled for October 2026.
Conclusion
This body of evidence demonstrates the digital innovation of SMS-delivered, patient-led malnutrition screening is reliable, valid, and scalable in cancer care outpatient settings. The digital solution offers enhanced patient autonomy with access to broader nutrition care services compared to traditional malnutrition screening pathways, resulting in delivery of high-value patient-centred care.