A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study

Abstract

Background Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528

Development and validation of a point‐of‐care nursing mobile tool to guide the diagnosis of malnutrition in hospitalized adult patients: a multicenter, prospective cohort study

“…In addition, the WeChat mini-program is compatible with various mobile operating systems, making it highly portable and accessible. 20,45 There are some limitations that need to be addressed. First, the validation of the model was only conducted on tumor patients in the second external verification set, and other types of patients were not included.…”

“…Our screening tool successfully makes the evaluation of nutritional status objective and visual, while simplifying the assessment and monitoring process for clinical doctors and nursing staff. In addition, the WeChat mini‐program is compatible with various mobile operating systems, making it highly portable and accessible 20,45 …”

“…R+ Dietitian was a mobile‐phone based mini program designed to provide nutritional risk screening and dietary assessment. In a previous study, it was compared with experienced dietitians, and found to have high accuracy, sensitivity, and specificity 20 . This mini program collects basic information from patients, and screens their nutritional risk.…”

“…To address this issue, we developed R+ Dietitian, a digital smartphone‐based self‐administered tool. R+ Dietitian enabled us to collect data from four different hospitals in China, including nutritional scales and facial screens 20 . The aim of this study was to develop and validate a point‐of‐care mobile tool to automatically extract and analyze facial features to screen malnourished patients with chronic disease.…”

“…R+ Dietitian enabled us to collect data from four different hospitals in China, including nutritional scales and facial screens. 20 The aim of this study was to develop and validate a point‐of‐care mobile tool to automatically extract and analyze facial features to screen malnourished patients with chronic disease. We also examined the suitability of NRS2002 and PG‐SGA SF questionnaire, and if any local features, such as eye contour, are more suitable for prediction (Figure 1 ).…”