Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The purpose of this project was to implement a patient led malnutrition screening tool in the Ipswich Hospital Oncology Day Unit.
Dates: November 2024 - August 2025
Implementation sites: West Moreton Hospital and Health Service
This project was presented as a Poster at CEQ Showcase 2026 (PDF 236 KB).
Aim
The goal of this project was to implement a self-led malnutrition screening tool in the Oncology Day Unit at Ipswich Hospital and to evaluate patient uptake over a six-month period following implementation.
Outcomes
Patient led screening was completed by 74 patients who presented to the oncology day unit for appointments or cancer treatment over a 6-month period. 32% (24/74) were identified as at risk of malnutrition with 67% (14/21) who had not yet seen a dietitian requesting an appointment. This enabled patients to be connected with a dietitian for an appointment without requiring multidisciplinary staff to initiate a referral.
Background
Malnutrition prevalence in patients with cancer is reported to be as high as 60-80% and has been found to negatively affect clinical outcomes and overall survival Identification of those at risk of malnutrition is crucial. In their evidenced based nutrition guidelines for adults, the Academy of Nutrition and Dietetics highlight the benefit of early and appropriate nutrition interventions to reduce treatment side effects, improve recovery, reduce hospital admissions and length of stay and improve quality of life for people with cancer
At West Moreton Health, patients with cancer are to be screened at regular timepoints by nursing staff with the malnutrition screening tool (MST). The MST is a validated, simple and reliable tool used to identify patients with cancer that are at risk of malnutrition. This tool asks patients two questions: 1) Have you been eating poorly due to a decreased appetite? and 2) Have you lost weight recently without trying. Patients are prompted to then report the amount of weight loss if this has occurred. A numerical result between 0 and 5 is generated based on answers, with nutrition risk being present with a score of 2 or more. Those at malnutrition risk are eligible for a referral to the West Moreton Health oncology dietitian for assessment and an individualised care plan.
An early 2024 chart review of outpatient oncology dietitian appointments at West Moreton Health revealed that many patients requiring dietitian input for malnutrition risk were not being referred to dietetics at key touchpoints within the hospital. When referrals were made, they often occurred late, at a median of 62 days after cancer diagnosis, by which time patients had already experienced a significant median of 11% weight loss. One contributing factor to these delays was the absence of completed dietetics referrals by staff, likely influenced by the high workload and competing demands within cancer care services.
A practical strategy to reduce the burden on staff to complete nutrition screening and placing referrals is the use of patient-led malnutrition screening. In this model, patients independently answer the malnutrition screening questions in their own time, and this can be reviewed by dietetics. Evidence demonstrates that patient-led screening accurately identifies ambulatory cancer care patients who are at risk of malnutrition and is both reliable and well-accepted within the ambulatory cancer care setting.
The central question we aimed to address was whether patient led malnutrition screening would be utilised by oncology patients within West Moreton Health and hence reduce the burden on staff to complete referrals to dietetics.
Methods
An iPad with an electronic MST was introduced into our regional hospital's oncology day unit. The application was developed utilising Outlook Power Apps. The tool asked standard malnutrition screening questions. Those who scored an MST of two or more progressed to a secondary page advising them on the importance of nutrition during cancer treatment and asking if they would like to see a dietitian. Patients could opt in our out (Y or N). Patient responses were uploaded to a Microsoft Teams list monitored by dietitians.
Consultation with the multidisciplinary cancer care team was undertaken to determine the most appropriate location and workflow for patient led malnutrition screening. During implementation, the location of the self-screening tool was amended due to staff feedback.
Consumers were actively involved throughout the development of the digital tool. Patients with cancer were engaged at multiple prototype stages to provide feedback on usability and design. West Moreton Health consumer feedback forms were used to guide this process. The insights gathered were incorporated into refinements of the application, including adjustments to text size and improvements to overall application flow.
Discussion
This project was supported by the West Moreton Health Allied Health Workforce Development Officers, who contributed to the development of the Power Apps application. The positive culture and strong patient-centred care values within the Oncology Day Unit at Ipswich also played an important role. Progress was further supported through backfill funding provided by the West Moreton Health Foundation.
In terms of challenges, several technological challenges contributed to delays in implementation. Additionally, despite some success with usage, completion rates overall have been quite low. The older oncology population within West Moreton presents challenges for engagement with a technology-based platform. Our next steps include identifying barriers faced by patients who do not complete the tool and exploring whether clinical assistants could support completion. We also plan to review the project using an implementation science framework and make changes based on findings.
A similar model of patient-led malnutrition screening has the potential to be adopted in other oncology day units across Queensland Health. The electronic tool developed by West Moreton Health using Power Apps could be shared with other sites for broader use. It could even be adapted for use in non-cancer care environments.
References
Di Bella A, Blake C, Young A, Pelecanos A, Brown T. Reliability of Patient-Led Screening with the Malnutrition Screening Tool: Agreement between Patient and Health Care Professional Scores in the Cancer Care Ambulatory Setting. J Acad Nutr Diet. 2018;118(6):1065-71. 10.1016/j.jand.2017.11.023
Di Bella A, Croisier E, Blake C, Pelecanos A, Bauer J, Brown T. Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting. Journal of the Academy of Nutrition and Dietetics. 2020 Jul;120(7):1210-1215. doi: 10.1016/j.jand.2019.10.015
Key contact
Alice Rogers
Dietitian
West Moreton Hospital and Health Service