Nutrition ALD: Effect of screening tool for malnutrition in advanced liver disease.

Aiming to develop and examine the acceptability, feasibility and effectiveness of a malnutrition screening tool encompassing physiological, psychosocial, emotional, financial, and cultural determinants of malnutrition for patients with ALD (with or without ascites). The tool will consist of yes/no questions relating to weight, appetite and physical symptoms along with non physiological factors affecting oral intake. Patients will be seen during a once only face to face (or via phone) standard care appointment at one regional and one metropolitan hospital liver service outpatient clinic, day stay or acute care inpatient admission. Data will be captured and stored using Redcap. Baseline Data: Baseline characteristics including measures of nutritional status (including anthropometry and bioimpedance monitoring) will be collected on each patient participant. Measurements will include Child Pugh classification and Charlson Comorbidity Index (CCI). Child Pugh classification will be calculated by existing gastroenterology clinicians from patient medical records. CCI will be collected via administrative data extract of patients’ electronic medical records during statistical analysis. Any data will be collected by the research team after the participants have provided informed consent. Intervention: A 30 minute pre-trial interview will be conducted consisting of semi-structured interviews at the first point of contact in standard care clinics. This may be weeks to months in advance of the intervention pending clinic appointments. At the following standard care clinic appointment all screening tools and assessments will be conducted in one 30 minute session. The Integrated Palliative care Outcome Scale (IPOS) will assess the physiological, psychosocial, emotional, financial, and cultural impacts of nutrition (or malnutrition) on health and quality of life for each participant, this tool will take less than 15 minutes to complete. Each participant will then complete four malnutrition screening tools: Royal Free Hospital-Nutrition Prioritising Tool (RFH-NPT), Malnutrition Screening Tool (MST), Patient Generated-Subjective Global Assessment Short Form (PGSGASF) and our novel malnutrition screening tool. Each screening tool takes approximately 5 minutes or less to complete. The Subjective Global Assessment (SGA) will be completed as per standard care practice with the research Dietitian and/or Dietitian Honours student.