Development and evaluation of an evidence-based, theory-grounded online Clinical Frailty Scale tutorial

Abstract

Introduction Frailty is a robust predictor of adverse outcomes in older people. Practice guidelines recommend routine screening for frailty; however, this does not occur regularly. The Clinical Frailty Scale (CFS) is a validated, feasible instrument that can be used in a variety of clinical settings and is associated with many adverse outcomes. Our objective was to develop and evaluate an online training module to guide frailty assessment using the CFS. Methods A multidisciplinary team of clinical experts developed an evidence-based, theory-grounded online training module for users who wished to perform frailty assessment using the CFS. The module was prospectively evaluated for user satisfaction, effectiveness and feasibility using a standardised questionnaire. Qualitative feedback was analysed with thematic analysis. Results Version 1 of the CFS module was used 627 times from 21 October 2019 to 24 March 2020. Satisfaction, effectiveness and feasibility of the module were positively rated (≥4/5 on a 5-point Likert scale n = 582 [93%], n = 507, [81%], n = 575, [91%], respectively). Qualitative feedback highlighted ease of use, likelihood of users to share the module with others and opportunities to increase multimedia content. Conclusion An online tutorial, designed using evidence and theory to guide frailty assessment using the CFS, was positively rated by users. The module’s content and structure was rated effective and feasible, and users were satisfied with, and likely to share, the module. Research evaluating the module’s impact on the accuracy of frailty assessment is required.

Measuring frailty and its association with key outcomes in the ambulance setting: a cross sectional observational study

“…We were unable to judge the study paramedics knowledge of the CFS following completion of the training package, nor determine their competency to apply it in clinical practice. However, similar online frailty training packages have been rated as effective, feasible, and met with high satisfaction from users [ 41 ].…”

PREPARE trial: a protocol for a multicentre randomised trial of frailty-focused preoperative exercise to decrease postoperative complication rates and disability scores

“…Standardisation of assessments and data collection can be challenging across sites in a multicentre trial. To address this, we have developed training modules to conduct assessments using the CFS 82 to standardise inclusion/exclusion criteria, and a training module to collect primary outcome using the POMS tool. Our coordinating centre will also centralise teaching, coaching, adherence calls and modifications for intervention arm participants.…”

“…Participants will be recruited either in person from surgical or anaesthesia clinics, or via telephone. Following surgical assessment and confirmation of the decision to operate, patients who consent for research contact, and who meet all inclusion criteria except for frailty score, will be assessed by a trained clinician or clinical assistant using the Clinical Frailty Scale (CFS) 82. Patients who score >4/9 on the CFS will then be offered the opportunity to provide written informed consent or verbal consent, respectively (see online supplemental file 1).…”

Geriatric assessment and treatment decision-making in surgical oncology

“…Another commonly used frailty screening tool is the Clinical Frailty Scale (CFS) which has evidence for incremental prognostic value and has been extensively studies in many settings 54–57. A short online module aids in training 58▪. In our practice, we employ the CFS.…”