A South Australian team has developed and validated a Cirrhosis Knowledge Questionnaire (CKQ) to assess patients’ disease knowledge and self-management capabilities.
It may help with patient education and their engagement with interventions such as salt restriction, monitoring of serum electrolytes or lactulose dose titration necessary to improve outcomes.
The CKQ, comprising seven questions related to complications such as ascites, variceal bleeding and hepatic encephalopathy, was developed with the assistance of 17 patients with decompensated cirrhosis then validated in a cohort of 109 patients from a Chronic Liver Failure Program.
Most patients (61%) had stable disease while the others had ongoing or a history of case management including components such as care plans, post-discharge phone calls, home visits, and enhanced support for patients and their carers.
The questionnaire showed most of the cohort (89%) were well aware of the need for ultrasound examinations every six months while a minority (33%) were aware of the need to titrate lactulose for worsening symptoms of hepatic encephalopathy.
Of interest, case managed patients had better knowledge scores than patients not receiving case management.
“This expected difference supports the validity of the instrument in evaluating knowledge of cirrhosis, because case managed patients received ongoing patient education as a part of their case management,” the study said
The study, published in Clinical Gastroenterology and Hepatology, said patient education is critical given that a quarter of readmissions were preventable in patients with cirrhosis.
However the study was not designed to establish the clinical relevance of using a CKQ, the authors said.
“Therefore, a further prospective cohort study is necessary to determine whether knowledge, as assessed by CKQ, correlates with clinically relevant endpoints, such as readmission rates and mortality.”
Senior investigator Professor Alan Wigg, head of hepatology and liver transplantation at Flinders Medical Centre, said in a statement that the number of chronic liver failure cases at South Australia’s public hospitals has increased more than three-fold from 422 in 2001 to 1,441 in 2015.
While alcohol remains the main cause for chronic liver failure, obesity-related liver disease (NAFLD) is expected to become a ‘modern epidemic’ by 2050.