MO1039HEALTH PROFESSIONAL PERSPECTIVES OF FRAILTY STATUS EVALUATION DURING PRE-TRANSPLANT ASSESSMENT
Authors: Wu Henry , Rushton Lyndsey , Biggins Fiona , Woywodt Alexander , Ahmed Aimun 
Published: May 2021

Background and Aims

The concept of frailty has garnered increased attention within nephrology in recent years, and there is increased debate on how frailty assessment could be utilized to inform shared decision-making around renal transplantation. A gold standard framework for frailty status workup in pre-transplant assessment remains unestablished. There are significant variations from the methods conducted by clinicians to determine frailty status during pre-transplant assessment. Our study aims to explore the perspectives of nephrology health professionals on frailty assessment in the pre-transplant clinic.

Method

A 5-item online survey was designed and sent through electronic mail to nephrology consultants, specialist registrars and specialist renal transplant nurses at a tertiary hospital in North West UK. Prior to survey distribution, the final edition was piloted by the authors. Study participants were given 3 weeks during Nov and Dec 2020 to respond. The survey was closed on 16 December 2020. In question 1, respondents are requested to comment on their current practices of frailty assessment in the pre-transplant clinic. Question 2 asked respondents to provide opinion whether frailty screening assessment tools - the Clinical Frailty Scale (CFS) and Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight (FRAIL) questionnaire are useful to help with decisions on patient suitability to progress with pre-transplant assessment. In question 3, respondents are asked to use the CFS and/or FRAIL questionnaire to provide score(s) if applicable, in which they feel a patient would be contraindicated to progress further in pre-transplant assessment. Question 4 asked respondents to share their opinion on whether frailty assessment should be formalized in pre-transplant clinic. Question 5 requested respondents to comment how pre-transplant frailty assessment could be further developed. Survey results were imported into a MS Excel Spreadsheet for analysis. Simple descriptive statistics were used for categorical data. Free text responses were grouped into themes and analyzed using simple qualitative techniques.

Results

31 staff members (16 consultants, 10 specialty registrars and 5 specialist renal transplant nurses) were invited to participate in the survey. 26 responses were received by 16 December 2020. 96% (25/26) of respondents commented that medical history gathered on a patient’s ability to perform activities of daily living is the main source used to obtain a general impression and estimate frailty status in the pre-transplant clinic. For 81% (21/26) of respondents, observation of mobility in clinic is also useful to help them determine a patient’s frailty status. While 85% (22/26) of respondents felt the FRAIL questionnaire was not suitable for pre-transplant assessment, 96% (25/26) of respondents agreed that the CFS is an appropriate and applicable frailty screening tool in this context. 92% (24/26) of respondents concur that a CFS score of 6 or higher suggests contraindication for renal transplantation. All 26 respondents agreed that frailty status evaluation should be a formalized process to determine suitability for transplant waitlisting. Popular suggestions to develop frailty assessment in pre-transplant clinic include setting up a frailty multidisciplinary team and frailty scoring system specific for pre-transplant assessment.

Conclusion

Our survey results suggest nephrology health professionals continue to rely heavily on medical history to evaluate frailty status. Incorporating frailty screening assessment tools such as the CFS prior to comprehensive geriatric assessment may be an option to assist shared decision-making of whether to proceed with next steps of the pre-transplant assessment. Future research initiatives could explore ways towards a systematic approach to frailty status workup and improve cost-effectiveness of the pre-transplant evaluation process.