A self-administered questionnaire may help improve cirrhosis care by evaluating patients' medication use and understanding, a recent study found.
Researchers developed My Cirrhosis Coach to measure patients' understanding regarding cirrhosis care and aimed to validate it in a prospective study. They enrolled adults with cirrhosis at three tertiary centers in Arizona and Indiana from July 2016 to July 2020 and used psychometric data, including confirmatory factor analysis, to develop and validate a final questionnaire. The content validity index (CVI) was used to measure content validity while expert ratings were used to measure accuracy. The study results were published Aug. 30 by Clinical Gastroenterology and Hepatology.
The cohort included 713 patients with cirrhosis and its complications, 582 outpatients and 131 inpatients. Forty-five percent had ascites, 42% had esophageal varices, and 33% had hepatic encephalopathy. The mean age was 59 years, 33% were Hispanic, 13% were American Indian, and 80% lived with another adult. Eligible patients completed the questionnaire during their clinic appointment or within 48 hours of discharge. The final domains included in the questionnaire were medication use and accessibility, medication obstacles, lactulose use, diuretic use, beta-blocker use, and dietary sodium use. Questions about specific medications were posed only to patients taking those medications.
Content validity and accuracy were rated as excellent, with a CVI score of 81% to 94% and expert ratings of 91% to 100%, respectively. Mean domain scores ranged from 1.1 to 2.6 on a scale of 0 to 3, with 3 indicating better performance. Patients who had a cirrhosis complication scored higher in the relevant medication domain, indicating more knowledge, and reported more medication obstacles. Inpatients scored higher than outpatients for all knowledge domains except salt use and reported more medication obstacles; those who died within 30 days of admission reported more obstacles than those who survived. Scores differed by income, education level, and whether the patient had another adult living at home.
The authors noted that My Cirrhosis Coach mainly focuses on medication knowledge and that their study examined only validation of the questionnaire, among other limitations. They concluded that My Cirrhosis Coach could be used to standardize medication use and measure patients' knowledge about cirrhosis in clinical practice, as well as in further research. “The care of patients with cirrhosis is complex, often requiring polypharmacy to minimize complications of this disease. The six domains of the MCC [My Cirrhosis Coach] are poised to evaluate medication use, obstacles and understanding for those navigating this complex journey,” the authors wrote. “We anticipate further studies using the MCC at the point of care and pre/post-intervention to improve knowledge while determining if knowledge is associated with cirrhosis-specific outcomes.”