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Development and Evaluation of a Patient Cirrhosis Knowledge Assessment

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Abstract

Background and Aims

Self-management skills improve outcomes for patients with cirrhosis. While education programs exist to teach these skills, there are limited patient assessments to evaluate their efficacy. We aimed to develop and evaluate cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis.

Methods

Across two institutions, a 4-stage process was undertaken: first, we developed a comprehensive set of questions regarding cirrhosis self-management. Second, the questions underwent critical review by patients and hepatology providers. Third, patients with cirrhosis answered these questions before and after a written educational tool. Questions were updated based on results. Fourth, patients answered the updated questions before and after a video educational tool. Binomial test or paired sample t-test was used to compare pre- and post-tests depending on question type.

Results

In phase 3, 134 patients completed pre- and post-tests. 44% were decompensated, 81% were diagnosed with cirrhosis at least 3 years, and 52% were 60–75 years. 95% of single-answer questions were answered correctly by at least 70% of patients in the pre-test. None of the answers improved significantly with education. After phase 3, 6 questions were removed and 6 questions were edited to increase challenge. In phase 4, 96 patients (42 compensated, 54 decompensated) completed pre- and post-tests. In the compensated assessment, 3 questions improved after education and the summative score increased (7.9 to 9.0, P < 0.001). In the decompensated assessment, 4 questions improved after education and the summative score increased (7.0 to 7.7, P = 0.004).

Conclusion

Through a rigorous process, we created and evaluated cirrhosis knowledge assessments for patients with compensated and decompensated cirrhosis. Further validation is required and then these assessments can be used to improve patient education.

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Data availability

Data will be made available to other researchers upon request.

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Funding

Patricia Bloom receives funding from the American College of Gastroenterology (ACG Junior Faculty Award). Emily Johnson receives funding from TRIANGLE (TRaIning A New generation of researchers in Gastroenterology and LivEr) Canada. Ashley Hyde receives funding from Mitacs Fellowship with Lupin Pharma. Puneeta Tandon received a grant which sponsors the development of cirrhosiscare.ca through Alberta Innovates Health Solutions (Grant Award Number: RES0043017).

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA

    Patricia P. Bloom

  2. Division of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Zheng Che

  3. Division of Gastroenterology (Liver Unit), Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Ashley Hyde, Emily Johnson, Michelle Carbonneau, Deepan Hazra & Puneeta Tandon

  4. Department of Occupational Therapy, University of Alberta, Edmonton, AB, Canada

    Antonio Miguel-Cruz

  5. Glenrose Rehabilitation Research, Innovation & Technology (GRRIT), Glenrose Rehabilitation Hospital, Edmonton, AB, Canada

    Antonio Miguel-Cruz

  6. University of Waterloo, Waterloo, ON, Canada

    Antonio Miguel-Cruz

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  1. Patricia P. Bloom
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  8. Puneeta Tandon
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Correspondence to Patricia P. Bloom.

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Conflict of interest

Patricia Bloom holds a research grant from Vedanta Biosciences and consults for Nexilico. Emily Johnson, Deepan Hazra, and Ashley Hyde have no conflicts to declare.

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Bloom, P.P., Che, Z., Hyde, A. et al. Development and Evaluation of a Patient Cirrhosis Knowledge Assessment. Dig Dis Sci 69, 399–409 (2024). https://doi.org/10.1007/s10620-023-08238-z

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