Faith D. Ottery

Assessing nutritional status in cancer: role of the Patient-generated Subjective Global Assessment

Purpose of review The Scored Patient-Generated Subjective Global Assessment (PG-SGA) is used internationally as the reference method for proactive risk assessment (screening), assessment, monitoring and triaging for interventions in patients with cancer. This review aims to explain the rationale behind and data supporting the PG-SGA, and to provide an overview of recent developments in the utilization of the PG-SGA and the PG-SGA Short Form. Recent findings The PG-SGA was designed in the context of a paradigm known as ‘anabolic competence’. Uniquely, the PG-SGA evaluates the patients status as a dynamic rather than static process. The PG-SGA has received new attention, particularly as a screening instrument for nutritional risk or deficit, identifying treatable impediments and guiding patients and professionals in triaging for interdisciplinary interventions. The international use of the PG-SGA indicates a critical need for high-quality and linguistically validated translations of the PG-SGA. Summary As a 4-in-1 instrument, the PG-SGA can streamline clinic work flow and improve the quality of interaction between the clinician and the patient. The availability of multiple high-quality language versions of the PG-SGA enables the inclusion of the PG-SGA in international multicenter studies, facilitating meta-analysis and benchmarking across countries.

Translation and cultural adaptation of the scored patient-generated subjective global assessment

Background: Assessment of malnutrition is important in cancer patients. The Scored Patient-Generated Subjective Global Assessment (PG-SGA), an instrument that enables interdisciplinary assessment of malnutrition and its risk factors, was not available in Dutch. Objective: Translation and cultural adaption of the original English PG-SGA to the Dutch setting. Methods: The PG-SGA was translated and culturally adapted, following the International Society for Pharmacoeconomics and Outcomes Research principles. Perceived content validity, comprehensibility, and difficulty were explored among a multidisciplinary sample of healthcare professionals and their cancer patients. Content validity, comprehensibility, and difficulty were operationalized by calculating item and scale indices. On scale level, indices of 0.80 to 0.90 were considered acceptable, and indices of 0.90 or greater were considered excellent. Results: Consensus was reached on 91 and 8 differences in the forward and back translations, respectively. Scale Content Validity Index was 0.89. Scale Comprehensibility Index and Scale Difficulty Index of the patient-generated component of the PG-SGA were 0.99 and 0.96, respectively. Scale Comprehensibility Index and Scale Difficulty Index of the professional component were 0.81 and 0.55, respectively. Conclusions: Translation and cultural adaptation of the PG-SGA according to the International Society for Pharmacoeconomics and Outcomes Research principles resulted in a Dutch version that maintained the purpose, meaning, and format and have acceptable content validity. Now a Dutch version of the PG-SGA is available that is considered comprehensible and easy by patients, and comprehensible and relevant by professionals. However, the professional component was considered difficult by the PG-SGA–naive professionals, which indicates a need for training. Implications for Practice: A similar systematic approach for future translations of the PG-SGA is recommended, to safeguard cultural equivalence.

MON-LB258: Does Training Improve Perceived Comprehensibility, Difficulty and Content Validity of the Portuguese Scored Pg-Sga?

Submission Identifier: ESPEN16-LB2-1909 DOES TRAINING IMPROVE PERCEIVED COMPREHENSIBILITY, DIFFICULTY AND CONTENT VALIDITY OF THE PORTUGUESE SCORED PG-SGA? Paula Pinto1, João P. Pinho* 1, Antónia Vigário2, Faith D. Ottery3, 4, Harriet Jager-Wittenaar3, 5 1Nutrition Services, Centro Hospitalar Médio Ave, EPE, V.N. Famalicão, 2Nutrition Services, Centro Hospitalar Médio Ave, EPE, Sto. Tirso, Portugal, 3Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, Netherlands, 4Ottery & Associates, Vernon Hills (Chicago), United States, 5Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands Please indicate your professional occupation: Dietitian Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA; ©FD Ottery 2005, 2006, 2015) is a validated instrument to assess malnutrition and its risk factors. Untrained professionals may experience some difficulties in using the physical exam component of the PG-SGA. We aimed to study whether training in the PG-SGA improves comprehensibility, difficulty (knowledge), and content validity (relevance) of the Portuguese PG-SGA, as perceived by Portuguese healthcare professionals and students in Nutrition and Food Science. Methods: 26 healthcare professionals (24 dietitians and 2 nurses) and 5 final year students in Nutrition and Food Science completed a questionnaire (70 items on comprehensibility; 35 on difficulty; 65 on content validity) using a 4-point Likert scale, preand post-PG-SGA training. Item and Scale Indices were calculated for comprehensibility (I-CI, S-CI), difficulty (I-DI, S-DI) and content validity (I-CVI, S-CVI). Scores ≥0.80 and ≥0.90 were considered acceptable and excellent, respectively. Wilcoxon signed rank test was used to test differences in S-CI, S-DI and S-CVI preand post-training. Results: Scores on comprehensibility (S-CI: 0.970) were excellent pre-training and even higher post-training (S-CI: 0.999, p<0.001). Acceptable difficulty (S-DI: 0.890) improved to excellent (S-DI: 1.000, p<0.001), in which items related to the physical examination were best improved (maximum difference in I-DI: 0.258). Scores on content validity were excellent both preand post-training (S-CVI>0.999; p=0.248). Conclusion: The PG-SGA was perceived as very comprehensible and relevant, both before and after training in the PG-SGA. Training in the PG-SGA helped Portuguese healthcare professionals and final year students in Nutrition and Food Science to further improve their knowledge on the PG-SGA. Disclosure of Interest: P. Pinto: None Declared, J. Pinho: None Declared, A. Vigário: None Declared, F. Ottery Other: coowner and co-developer of the PG-SGA based Pt-Global app, H. Jager-Wittenaar Other: co-developer of the PG-SGA based Pt-Global app

SUN-PP209: Dutch Patient-Generated Subjective Global Assessment (PG-SGA): Training Improves Scores for Comprehensibility and Difficulty

Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess and monitor malnutrition, which consists of both patient-reported and professional-reported items. A professional should be able to correctly interpret all items. Untrained professionals may experience difficulty in completing some items of the PG-SGA. We aimed to explore the change in perceived comprehensibility and difficulty of the Dutch PG-SGA by health care professionals on the use of the instrument, before and after training. Methods: A sample of 36 untrained health care professionals, of which 34 dietitians, completed a set of 29 items on a four point scale regarding comprehensibility and difficulty of the PG-SGA on two separate occasions: T0) two weeks before and T1) directly after an instructional session on the PG-SGA and training with the physical exam. Summarized comprehensibility indexes (SCI) and difficulty indexes (SDI) were calculated for the patient part of the PG-SGA (aka PG-SGA Short Form; PG-SGA SF), the professional part of the PG-SGA (PG-SGApro) and the full PG-SGA, to quantify the level of perceived comprehensibility and difficulty. SCI≥0.80 and SDI≥0.80 were considered acceptable, SCI≥0.90 and SDI≥0.90 were considered excellent. Results: SCI of the PG-SGA SF was acceptable both before (SCI: 0.80) and after training (SCI: 0.89). SCI of the PG-SGApro and full PG-SGA changed from unacceptable (SCI: 0.64; 0.69) to excellent (SCI: 0.95; 0.94). All SDIs changed from unacceptable (SDI for respectively PG-SGA SF, PG-SGApro and full PG-SGA: 0.71; 0.50; 0.57) to acceptable (SDI: 0.88; 0.85; 0.87). Conclusion: Training professionals in the use of the PG-SGA can be an effective strategy for improving the level of both comprehensibility and difficulty.

Prevalence and characteristics of risk for malnutrition in patients with newly diagnosed head and neck cancer

Topic: Nutritional assessment Abstract Submission Identifier: ESPEN17-ABS-1608 PREVALENCE AND CHARACTERISTICS OF RISK FOR MALNUTRITION IN PATIENTS WITH NEWLY DIAGNOSED HEAD AND NECK CANCER L. ter Beek*, 1, 2, 3, L. Bras 4, J. L. Roodenburg 3, C. P. van der Schans 1, 5, 6, F. D. Ottery 1, 7, G. B. Halmos 4, H. JagerWittenaar 1, 3 1Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 2Department of Pulmonary Diseases and Tuberculosis, 3Department of Maxillofacial Surgery, 4Department of Otorhinolaryngology, Division of Head and Neck Surgery, 5Department of Rehabilitation Medicine, 6Department of Health Psychology Research, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 7Ottery & Associates, Vernon Hills (Chicago), United States

Nutritional assessment 2MON-P195: Diagnostic Accuracy of ESPEN Diagnostic Criteria for Malnutrition in Selected Clinical Populations

Submission Identifier: ESPEN17-ABS-1516 DIAGNOSTIC ACCURACY OF ESPEN DIAGNOSTIC CRITERIA FOR MALNUTRITION IN SELECTED CLINICAL POPULATIONS P. Dewansingh*, 1, 2, L. ter Beek 1, 3, 4, M. Euwes 5, G. van der Sluis 6, F. D. Ottery 1, 7, C. P. van der Schans 1, 8, 9, 10, H. Jager-Wittenaar 1, 11 1Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, 2 Nutrition and dietetics, Nij Smellinghe Hospital, Drachten, 3Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, 4Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, 5General Health care , 6Department of Physical Therapy, Nij Smellinghe Hospital, Drachten, Netherlands, 7 Ottery & Associates, Vernon Hills (Chicago), United States, 8Faculty of Medical Sciences, 9Dept. of Rehabilitation Medicine, 10 Dept. of Health Psychology Research, 11Dept. of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands Presentation Method: Oral or Poster presentation Please indicate your professional occupation: Other The presenting author fulfills the above conditions and wants to apply for a travel award: No The presenting author fulfills the above conditions and wants to apply for the ESPEN Prize: No Rationale: We aimed to assess diagnostic accuracy of ESPEN’s Diagnostic Criteria for malnutrition (EDC), as compared to the Patient-Generated Subjective Global Assessment (PG-SGA) in selected clinical populations. Methods: In two hospitals, in 174 patients (67.5±10.3 yrs; COPD: n=116; colon/rectum cancer: n=21; orthopedic: n=37) malnutrition was assessed by EDC and PG-SGA. According to EDC, malnutrition was defined as having at least one of the following criteria: 1) BMI <18.5 kg/m2; 2) combination of unintentional weight loss (>10% of habitual weight indefinite of time, or >5% over 3 months) and low BMI (<20 or <22 kg/m2 in subjects younger and older than 70 yrs, respectively) and/or a low fat-free mass index (FFMI) by bio-electrical impedance (<15 [female] and <17 kg/m2 [male]). As reference, malnutrition was defined as PGSGA Stage B (moderately/suspected malnutrition) or Stage C (severely malnourished). Diagnostic accuracy was assessed by sensitivity, specificity, positive and negative predictive value, and ROC curve. Results: According to EDC and PG-SGA, 6.9% and 31% were malnourished, respectively. For COPD, colon/rectum cancer, and orthopedic patients, prevalence was 9.5% and 39.7%, 4.8% and 19%, and 0% and 10.8% respectively. Overall sensitivity, specificity, positive and negative predictive value were 0.15, 0.97, 0.85 and 0.03, respectively. The area under the ROC curve (AUC) was 0.56 (p=0.23) for the total population. For COPD, colon/rectum cancer, and orthopedic patients AUC was 0.55 (p=0.39), 0.63 (p=0.45), and 0.50 (p=1.00), respectively. Conclusion: In COPD, rectum-/colon cancer, and orthopedic patients, diagnostic accuracy of EDC as compared to the PG-SGA is low, especially sensitivity and negative predictive value. Consequently, using EDC in these populations is likely to result in underrecognition of malnutrition, which may hinder timely and adequate treatment of malnutrition. Disclosure of Interest: P. Dewansingh: None Declared, L. ter Beek: None Declared, M. Euwes: None Declared, G. van der Sluis: None Declared, F. Ottery Other: Developer of the PG-SGA, co-developer of the PG-SGA based Pt-Global app, C. van der Schans: None Declared, H. Jager-Wittenaar Other: Co-developer of the PG-SGA based Pt-Global app

SUN-P173: Feasibility of the Patient-Generated Subjective Global Assessment (PG-SGA) in Long-Stay Nursing Home Residents

In this cross-sectional study, we assessed the feasibility of completing the Patient-Generated Subjective Global Assessment (PG-SGA) in long-stay nursing home residents.

MON-LB025: Agreement Between PG-SGA Short Form, Must and Snaq in Hospital Patients

Rationale: The Patient-Generated Subjective Global Assessment (PG-SGA) is a validated instrument to assess malnutrition and its risk factors in clinical populations. Its patient component, PG-SGA Short Form (SF), can be used as screening instrument. In this cross-sectional study we aimed to assess agreement between the PG-SGA SF, Malnutrition Universal Screening Tool (MUST), and Short Nutritional Assessment Questionnaire (SNAQ) in patients at the University Medical Center Groningen, The Netherlands. Methods: Malnutrition risk was assessed by PG-SGA SF, MUST, and SNAQ in 81 patients from the Departments Ear Nose Throat (ENT), Oral and Maxillofacial Surgery (OMS) and Orthopedics. Point scores of PG-SGA SF=4-8, MUST=1, and SNAQ=2 were classified as ‘medium malnutrition risk’, and PG-SGA SF≥9, MUST ≥2, and SNAQ ≥3 as ‘high malnutrition risk’. Agreement in classification for malnutrition risk was assessed by weighted kappa (κ) and intra-class correlation coefficient (ICC). A p-value of <0.05 was considered statistically significant. Results: According to the PG-SGA SF, MUST and SNAQ, respectively 65%, 81%, and 80% of all patients were classified as ‘low malnutrition risk’; 24%, 8% and 6% as ‘medium malnutrition risk’; 11%, 10% and 14% as ‘high malnutrition risk’. Agreement between PG-SGA SF and MUST (κ=0.452, ICC=0.448; p<0.001), and between PG-SGA SF and SNAQ (κ=0.395, ICC=0.395; p<0.001) were both fair. In patients from the Departments ENT and OMS, PG-SGA SF classified more patients at medium/high malnutrition risk (n=26) as compared to the MUST (n=12) or SNAQ (n=14). Conclusion: We found only fair agreement between the PG-SGA SF and MUST and SNAQ, respectively. The PG-SGA SF classified three and four times more patients at medium malnutrition risk, compared to MUST and SNAQ respectively, due to its scoring on symptoms and activities/functioning. Hence, the PG-SGA SF may help facilitate proactive prevention of malnutrition.