Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2022-08-31 , DOI: 10.1016/j.cgh.2022.08.025 Archita P Desai 1 , Shahd Duzdar 2 , Timothy Stump 3 , Eric S Orman 1 , Lauren Nephew 1 , Kavish R Patidar 1 , Marwan S Ghabril 1 , Geoffrey Block 4 , Michael Fallon 5 , Naga Chalasani 3 , Patrick O Monahan 2
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Background and Aim
While patient knowledge is modifiable, there are no widely accepted tools to measure patient understanding during cirrhosis care. We aimed to develop and validate “My Cirrhosis Coach” (MCC), a personalized, self-administered questionnaire to evaluate cirrhosis-related medication use, obstacles and understanding.
Methods
Adults with cirrhosis were prospectively enrolled at three tertiary centers from 7/2016 – 7/2020. Psychometrics including confirmatory factor analysis was used to develop and validate a final questionnaire. Content validity was measured via the content validity index (CVI) and expert performance. Discriminant validity was assessed by comparing scores between groups hypothesized to have varying performance.
Results
The MCC was tested in a diverse cohort (n=713) with cirrhosis and its complications including ascites (45%) and hepatic encephalopathy (33%) with median MELD-Na 10 (IQR 9-15). A 6-factor model of the MCC fit the data well (RMSEA 0.22, CFI 0.96, SRMR 0.104; final domains: Medication Use & Accessibility, Medication Obstacles, Lactulose Use, Diuretic Use, Beta-blocker Use, and Dietary Sodium Use). The MCC had excellent content validity(CVI 81-94%) and accuracy(91-100%) ratings by experts. Mean domain scores ranged from 1.1-2.6(range 0-3, 3 indicating better performance). Those with a cirrhosis complication scored higher in the relevant medication domain(i.e., diuretic use score in ascites). Compared to outpatients, inpatients scored higher in all knowledge domains except salt use and reported more medication obstacles. Scores differed by income, education level, and having an adult at home.
Discussion
In a large, diverse cohort, we validated the My Cirrhosis Coach which can serve to standardize medication use and knowledge measurement in clinical practice and education-based studies in cirrhosis.
中文翻译：
衡量肝硬化患者的药物使用情况、障碍和知识
背景和目标
虽然患者的知识是可以修改的，但在肝硬化护理期间没有广泛接受的工具来衡量患者的理解。我们的目的是开发和验证“我的肝硬化教练”(MCC)，这是一种个性化的、自我管理的问卷，用于评估与肝硬化相关的药物使用、障碍和理解。
方法
2016 年 7 月至 2020 年 7 月期间，前瞻性地在三个三级中心招募了患有肝硬化的成人。使用包括验证性因素分析在内的心理测量学来制定和验证最终调查问卷。内容效度通过内容效度指数（CVI）和专家表现来衡量。通过比较假设具有不同表现的组之间的分数来评估区分效度。
结果
MCC 在患有肝硬化及其并发症（包括腹水 (45%) 和肝性脑病 (33%)）的不同队列 (n=713) 中进行测试，中位 MELD-Na 10 (IQR 9-15)。MCC 的 6 因素模型与数据吻合良好（RMSEA 0.22、CFI 0.96、SRMR 0.104；最终领域：药物使用和可及性、药物障碍、乳果糖使用、利尿剂使用、β 阻滞剂使用和膳食钠使用）。MCC 具有出色的内容效度（CVI 81-94%）和准确性（91-100%）专家评级。平均领域得分范围为 1.1-2.6（范围 0-3，3 表示性能更好）。患有肝硬化并发症的患者在相关药物领域得分较高（即腹水利尿剂使用得分）。与门诊患者相比，住院患者在除盐使用之外的所有知识领域得分更高，并且报告了更多的用药障碍。分数因收入而异，
讨论
在一个大型、多样化的队列中，我们验证了“我的肝硬化教练”，它可以标准化肝硬化临床实践和基于教育的研究中的药物使用和知识测量。
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