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Correia T, Martins MM, Barroso F, Pinho L, Longo J, Valentim O. The Family's Contribution to Patient Safety. NURSING REPORTS 2023; 13:634-643. [PMID: 37092484 PMCID: PMC10123717 DOI: 10.3390/nursrep13020056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Person- and family-centered care is one of the recommendations to achieve quality of care and patient safety. However, many health professionals associate the family with insecurity in care. OBJECTIVE To analyze, based on nurses' statements, the advantages and disadvantages of the family's presence in hospitals for the safety of hospitalized patients. METHODS This was a qualitative interpretative study based on James Reason's risk model, conducted through semi-structured interviews with 10 nurses selected by convenience. A content analysis was performed using Bardin's methodology and MAXQDA Plus 2022 software. RESULTS We identified 17 categories grouped according to the representation of the family in patient safety: The family as a Potentiator of Security Failures (7) and Family as a Safety Barrier (10). CONCLUSIONS The higher number of categories identified under Family as a Safety Barrier shows that nurses see strong potential in the family's involvement in patient safety. By identifying the need to intervene with and for families so that their involvement is safe, we observed an increase in the complexity of nursing care, which suggests the need to improve nursing ratios, according to the participants.
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Affiliation(s)
- Tânia Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Escola Superior de Saúde de Viseu (ESSV), Instituto Politécnico de Viseu (IPV), 3500-843 Viseu, Portugal
| | - Maria Manuela Martins
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto (UP), 4050-313 Porto, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Escola Superior de Enfermagem do Porto (ESEP), 4050-313 Porto, Portugal
| | | | - Lara Pinho
- Nursing Department, Universidade de Évora, 7000-811 Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-811 Évora, Portugal
| | - João Longo
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Escola Superior de Saúde Ribeiro Sanches (ERISA)-IPLUSO, 1950-396 Lisboa, Portugal
| | - Olga Valentim
- CINTESIS@RISE, Nursing School of Porto (ESEP), 4200-450 Porto, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1990-096 Lisboa, Portugal
- Escola Superior de Enfermagem de Lisboa (ESEL), 1600-096 Lisboa, Portugal
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Ljungholm L, Klinga C, Edin-Liljegren A, Ekstedt M. What matters in care continuity on the chronic care trajectory for patients and family carers?-A conceptual model. J Clin Nurs 2021; 31:1327-1338. [PMID: 34351651 DOI: 10.1111/jocn.15989] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers. BACKGROUND Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles. DESIGN A constructivist grounded theory approach was applied. METHODS Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed. RESULTS A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation. CONCLUSION Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances. RELEVANCE TO CLINICAL PRACTICE The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.
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Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anette Edin-Liljegren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Ernecoff NC, Altieri-Dunn SC, Bilderback A, Wilson CL, Saxon S, Ahuja Yende N, Arnold RM, Boninger M. Evaluation of a Home-Based, Nurse Practitioner-led Advanced Illness Care Program. J Am Med Dir Assoc 2021; 22:2389-2393. [PMID: 34115993 DOI: 10.1016/j.jamda.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In the United States, people with serious illness often experience gaps and discontinuity in care. Gaps are frequently exacerbated by limited mobility, need for social support, and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program provides nurse practitioner-led, home-based care for people with serious or complex chronic illnesses that specifically targets palliative care needs and coordinates with patients' primary care and specialty health care providers. We sought to investigate the effect of the AIC Program on hospital encounters [hospitalizations and emergency department (ED) visits], hospice conversion, and mortality. DESIGN Retrospective nearest-neighbor matching. SETTING AND PARTICIPANTS Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment to fee-for-service Medicare controls at 9 hospitals within one health system. METHODS We matched on demographic characteristics and comorbidities, with exact matches for diagnosis-related group and home health enrollment. Outcomes were hospital encounters (30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day mortality. RESULTS We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls, AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points, confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points, CI -17.7, -5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points, CI 11.4, 33.3; P < .001). CONCLUSIONS The AIC Program provides care and coordination that the home-based serious illness population may not otherwise receive. IMPLICATIONS By identifying and addressing care needs and gaps in care early, patients may avoid unnecessary hospitalizations and receive timely hospice services as they approach the end of life.
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Affiliation(s)
- Natalie C Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | | | | | | | - Susan Saxon
- Palliative and Supportive Institutive, UPMC, Pittsburgh, PA, USA
| | - Namita Ahuja Yende
- Innovative Homecare Solutions, UPMC, Pittsburgh, PA, USA; UPMC Health Plan, Pittsburgh, PA, USA; Division of Geriatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert M Arnold
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Palliative and Supportive Institutive, UPMC, Pittsburgh, PA, USA
| | - Michael Boninger
- Innovative Homecare Solutions, UPMC, Pittsburgh, PA, USA; Department of Physical Medicine & Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Östman M, Bäck-Pettersson S, Sundler AJ, Sandvik AH. Nurses' experiences of continuity of care for patients with heart failure: A thematic analysis. J Clin Nurs 2020; 30:276-286. [PMID: 33141466 DOI: 10.1111/jocn.15547] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/06/2020] [Accepted: 10/23/2020] [Indexed: 01/04/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to describe nurses' experiences of continuity of care for patients with heart failure. BACKGROUND Heart failure is a life-influencing condition that causes varying care needs over time with risks of fragmentation. Nurses play an important role in caring for patients with heart failure. However, nurses' experiences of continuity of care seem to be less explored in this context. DESIGN A qualitative study with a descriptive design. METHODS Four focus groups were chosen to collect the data, and the analysis was made by using a method for thematic analysis. A purposeful sampling of nurses (n = 14) with experiences from hospital-connected heart failure clinics, primary healthcare centres and municipal home healthcare settings was recruited. The COREQ checklist was used in this study. RESULTS The nurses' experiences of continuity of care for patients with heart failure were described in four themes: access and flexibility, responsibility and transparency, trustful and caring relationships and communication and collaboration. CONCLUSIONS The results indicate that nurses have an excellent position to act as the "hub" in caring for patients with heart failure, but they need to have the possibility of networking and establishing trusting relationships with their colleagues. From the nurses' point of view, mutual trust between the nurse, the patient and the patient's next of kin is crucial for promoting and maintaining continuity of care in patients with heart failure. RELEVANCE TO CLINICAL PRACTICE To promote continuity of care for patients with heart failure, nurses expressed the necessity of establishing trusting relationships in a continuity-promoting organisation with seamless coordination. Nurses can be the "hub" supporting a person-centred care approach based on the patients' needs. There seems to be a need for better collaboration with common guidelines across and within primary healthcare centres, hospital-connected heart failure clinics and municipal home healthcare settings.
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Affiliation(s)
- Malin Östman
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Region Västra Götaland, Närhälsan Källstorp Health Centre, Trollhättan, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Siv Bäck-Pettersson
- Region Västra Götaland, Research and Development Primary Health Care, R, D&E Centre Fyrbodal, Västra Götaland, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Ann-Helén Sandvik
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Yue P, Xu T, Greene B, Wang Y, Wang R, Dai G, Xu L. Caring in community nursing practice: Inductive content analysis reveals an inter-dynamic system between patients and nurses. J Clin Nurs 2020; 29:3025-3041. [PMID: 32353918 DOI: 10.1111/jocn.15312] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/15/2020] [Accepted: 04/12/2020] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To examine the understanding of caring in the practice of community nursing from the perspectives of patients and nurses. BACKGROUND An increasing population of patients with chronic disease has produced a need for humanistic caring in communities. As a result, caring has become a core value of community nursing professionals. However, community nurses meet many difficulties in trying to practice person-centred care with their clients. Furthermore, most community nurses-especially in China-lack systematic education and training about caring because the practical meaning of caring in community practice is unknown. DESIGN The qualitative study described herein employed inductive content analysis. METHODS Eleven community patients with chronic disease and fifteen community nurses who were nominated as a caring nurse from different community clinics in Beijing, China, participated in thirty-one interviews during January to August in 2018. Nine documents from the interviewed nurses were collected. Both interview data and documents were analysed using strategies of inductive content analysis. The COREQ checklist was used. RESULTS Patients and their corresponding nurses described a wide range of caring experiences that were generalised into 28 concepts. Caring emerged as an inter-dynamic system that comprised the foundation and quality of a caring relationship, the caring philosophy and behaviours of interactions, and positive feedback from caring interactions. A relationship-based framework of caring in community nursing practice was constructed. CONCLUSIONS Identifying this systematic concept of caring provides insights that are applicable to the creation of targeted management, education and practice interventions to ultimately enhance the quality of community health care-in China or elsewhere. RELEVANCE TO CLINICAL PRACTICE The systematic understanding of caring in community nursing practice will inform nurses in community health clinics, their educators and their managers on how to provide care to community patients and how to develop caring competence for community nurses.
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Affiliation(s)
- Peng Yue
- School of Nursing, Capital Medical University, Beijing, China
| | - Tianmeng Xu
- School of Nursing, Capital Medical University, Beijing, China
| | - Brian Greene
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yongli Wang
- Yuetan Community Health Service Center, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Rongjin Wang
- School of Nursing, Capital Medical University, Beijing, China
| | - Guizhi Dai
- Yongdingmenwai Community Health Service Center, Dongcheng District, Beijing, China
| | - Lijie Xu
- School of Nursing, Capital Medical University, Beijing, China
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Ang IYH, Ng SHX, Rahman N, Nurjono M, Tham TY, Toh SA, Wee HL. Right-Site Care Programme with a community-based family medicine clinic in Singapore: secondary data analysis of its impact on mortality and healthcare utilisation. BMJ Open 2019; 9:e030718. [PMID: 31892645 PMCID: PMC6955507 DOI: 10.1136/bmjopen-2019-030718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Stable patients with chronic conditions could be appropriately cared for at family medicine clinics (FMC) and discharged from hospital specialist outpatient clinics (SOCs). The Right-Site Care Programme with Frontier FMC emphasised care organised around patients in community rather than hospital-based providers, with one identifiable primary provider. This study evaluated impact of this programme on mortality and healthcare utilisation. DESIGN A retrospective study without randomisation using secondary data analysis of patients enrolled in the intervention matched 1:1 with unenrolled patients as controls. SETTING Programme was supported by the Ministry of Health in Singapore, a city-state nation in Southeast Asia with 5.6 million population. PARTICIPANTS Intervention group comprises patients enrolled from January to December 2014 (n=684) and control patients (n=684) with at least one SOC and no FMC attendance during same period. INTERVENTIONS Family physician in Frontier FMC managed patients in consultation with relevant specialist physicians or fully managed patients independently. Care teams in SOCs and FMC used a common electronic medical records system to facilitate care coordination and conducted regular multidisciplinary case conferences. PRIMARY OUTCOME MEASURES Deidentified linked healthcare administrative data for time period of January 2011 to December 2017 were extracted. Three-year postenrolment mortality rates and utilisation frequencies and charges for SOC, public primary care centres (polyclinic), emergency department attendances and emergency, non-day surgery inpatient and all-cause admissions were compared. RESULTS Intervention patients had lower mortality rate (HR=0.37, p<0.01). Among those with potential of postenrolment polyclinic attendance, intervention patients had lower frequencies (incidence rate ratio (IRR)=0.60, p<0.01) and charges (mean ratio (MR)=0.51, p<0.01). Among those with potential of postenrolment SOC attendance, intervention patients had higher frequencies (IRR=2.06, p<0.01) and charges (MR=1.86, p<0.01). CONCLUSIONS Intervention patients had better survival, probably because their chronic conditions were better managed with close monitoring, contributing to higher total outpatient attendance frequencies and charges.
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Affiliation(s)
- Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sheryl Hui-Xian Ng
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nabilah Rahman
- Regional Health System Office, National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Milawaty Nurjono
- Centre for Health Services and Policy Research (CHSPR), Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Tat Yean Tham
- Clinical Affairs Department, Frontier Healthcare Group, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sue-Anne Toh
- Regional Health System Office, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Population Health Improvement Centre (SPHERiC), National University Health System, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Faculty of Science, National University of Singapore, Singapore, Singapore
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Lee YL, Cui YY, Tu MH, Chen YC, Chang P. Mobile Health to Maintain Continuity of Patient-Centered Care for Chronic Kidney Disease: Content Analysis of Apps. JMIR Mhealth Uhealth 2018; 6:e10173. [PMID: 29678805 PMCID: PMC5935804 DOI: 10.2196/10173] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/17/2018] [Accepted: 03/17/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global health problem with a high economic burden, which is particularly prevalent in Taiwan. Mobile health apps have been widely used to maintain continuity of patient care for various chronic diseases. To slow the progression of CKD, continuity of care is vital for patients' self-management and cooperation with health care professionals. However, the literature provides a limited understanding of the use of mobile health apps to maintain continuity of patient-centered care for CKD. OBJECTIVE This study identified apps related to the continuity of patient-centered care for CKD on the App Store, Google Play, and 360 Mobile Assistant, and explored the information and frequency of changes in these apps available to the public on different platforms. App functionalities, like patient self-management and patient management support for health care professionals, were also examined. METHODS We used the CKD-related keywords "kidney," "renal," "nephro," "chronic kidney disease," "CKD," and "kidney disease" in traditional Chinese, simplified Chinese, and English to search 3 app platforms: App Store, Google Play, and 360 Mobile Assistant. A total of 2 reviewers reached consensus on coding guidelines and coded the contents and functionalities of the apps through content analysis. After coding, Microsoft Office Excel 2016 was used to calculate Cohen kappa coefficients and analyze the contents and functionalities of the apps. RESULTS A total of 177 apps related to patient-centered care for CKD in any language were included. On the basis of their functionality and content, 67 apps were recommended for patients. Among them, the most common functionalities were CKD information and CKD self-management (38/67, 57%), e-consultation (17/67, 25%), CKD nutrition education (16/67, 24%), and estimated glomerular filtration rate (eGFR) calculators (13/67, 19%). In addition, 67 apps were recommended for health care professionals. The most common functionalities of these apps were comprehensive clinical calculators (including eGFR; 30/67; 45%), CKD medical professional information (16/67, 24%), stand-alone eGFR calculators (14/67, 21%), and CKD clinical decision support (14/67, 21%). A total of 43 apps with single- or multiple-indicator calculators were found to be suitable for health care professionals and patients. The aspects of patient care apps intended to support self-management of CKD patients were encouraging patients to actively participate in health care (92/110, 83.6%), recognizing and effectively responding to symptoms (56/110, 50.9%), and disease-specific knowledge (53/110, 48.2%). Only 13 apps contained consulting management functions, patient management functions or teleconsultation functions designed to support health care professionals in CKD patient management. CONCLUSIONS This study revealed that the continuity of patient-centered care for CKD provided by mobile health apps is inadequate for both CKD self-management by patients and patient care support for health care professionals. More comprehensive solutions are required to enhance the continuity of patient-centered care for CKD.
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Affiliation(s)
- Ying-Li Lee
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan.,Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan
| | - Yan-Yan Cui
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hsiang Tu
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Chi Chen
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Polun Chang
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Tang E, Bansal A, Novak M, Mucsi I. Patient-Reported Outcomes in Patients with Chronic Kidney Disease and Kidney Transplant-Part 1. Front Med (Lausanne) 2018; 4:254. [PMID: 29379784 PMCID: PMC5775264 DOI: 10.3389/fmed.2017.00254] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/21/2017] [Indexed: 01/31/2023] Open
Abstract
Chronic kidney disease (CKD) is a complex medical condition that is associated with several comorbidities and requires comprehensive medical management. Given the chronic nature of the condition, its frequent association with psychosocial distress, and its very significant symptom burden, the subjective patient experience is key toward understanding the true impact of CKD on the patients’ life. Patient-reported outcome measures are important tools that can be used to support patient-centered care and patient engagement during the complex management of patients with CKD. The routine collection and use of patient-reported outcomes (PROs) in clinical practice may improve quality of care and outcomes, and may provide useful data to understand the disease from both an individual and a population perspective. Many tools used to measure PROs focus on assessing health-related quality of life, which is significantly impaired among patients with CKD. Health-related quality of life, in addition to being an important outcome itself, is associated with clinical outcomes such as health care use and mortality. In Part 1 of this review, we provide an overview of PROs and implications of their use in the context of CKD. In Part 2, we will review the selection of appropriate measures and the relevant domains of interest for patients with CKD.
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Affiliation(s)
- Evan Tang
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, Division of Nephrology, University Health Network, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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