16. What does ‘patient-generated’ mean?

16. What does ‘patient-generated’ mean?

The original SGA was developed as an assessment tool to be performed by a professional – originally the physician but this has expanded to performance by other professionals such as dietitians and nurses.

There were two key reasons that the creators of the PG-SGA© utilized patient (self) input rather than utilizing the commonly used question and answer approach.

1) Appropriate Use of Professional’s Limited Time
Professionals may agree that nutritional status, assessment, and intervention are important but unfortunately if time is short, nutrition screening/assessment tend to be very limited in scope or dropped from the standard clinical visit.

Use of the PG-SGA© allows the patient to complete this important information while waiting for the professional prior to the visit (in the waiting room, the exam room, or at home on the day of the visit). This approach served two purposes. First, it ensures that nutritional assessment is included in the patient’s visit and second, it streamlines the visit and serves to improve the outcomes of that interaction. Rather than spending the professional’s limited time asking questions, the PG-SGA allows the patient to identify issues that need to be addressed by the professional during the interaction.

Since there are numerous publications and research that support the importance of nutritional status, particularly protein status and/or lean tissue status as important predictors of clinical outcome, it is imperative that nutrition be included in every patient visit, particularly in chronic catabolic and potentially disabling medical conditions including cancer, HIV/AIDS, chronic pulmonary and cardiac disease, trauma, conditions/treatments such as brain radiation therapy, therapy of hematologic malignancies, or exacerbations of inflammatory bowel disease where high dose corticosteroids may be used for more a few days etc.

Some professionals may feel that the only way to stop catabolic weight loss is to “treat and cure” or “remove” the underlying cause of the catabolism. While this is an important component, an individual can loose very significant amounts of weight (e.g., predominantly lean tissue mass and compromised protein status with associated immunodepression) until that goal is reached.

2) Patient Involvement – identification and empowerment
Involvement of the patient gets to the core of the problem.

In the validation of the point scores in 1996 involving 2,150 patients and 55 centers, more than 1/3 of the professionals stated that use of the PG-SGA© changed their appreciation of treatable nutritional risk or nutritional deficit. Raters in the study were dietitians (52%), nurses (40%), physicians (0.1%), others (8%).

Importantly, the PG-SGA© involves the patient in the clinical process and gives them back some of the control they may feel they have lost by being a patient. With patients completing the form, one gets the information from their perspective, may identifiy symptoms that neither family nor professionals were aware of (perhaps from perspective of embarassment or not wanting to “complain”). Also, if the check off list is in the patient’s native language (the long term goal of the multilingual app) then the ability of the patient to be a part of the care can be significantly enhanced.