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Keriakos M, Lee S, Stannard C, Ariss S, Dunn L, Wilkie M, Fotheringham J. Supporting patient self-management: A cross-sectional and prospective cohort study investigating Patient Activation Measure (PAM) and Clinician Support for PAM scores as part of a multi-centre haemodialysis breakthrough series collaborative. PLoS One 2024; 19:e0303299. [PMID: 38776355 PMCID: PMC11111028 DOI: 10.1371/journal.pone.0303299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 04/23/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Patient self-management, measured by the Patient Activation Measure (PAM), is associated with reduced healthcare utilisation and better health-related quality of life. Self-management in haemodialysis (HD) is challenging and may require support from clinicians with positive attitudes towards self-management, measured by the Clinician Support for PAM (CSPAM). OBJECTIVES To assess whether kidney staff CSPAM scores are: 1) associated with their centre's patient PAM scores and 2) modifiable through staff coaching. METHODS Baseline PAM and CSPAM and six-month CSPAM were collected from HD patients and kidney staff respectively in seven UK kidney centres as part of a six-month breakthrough series collaborative (BTSC), which trained kidney staff in supporting patient independence with HD tasks. Firstly, multivariable linear regression analyses adjusted for patient characteristics were used to test the baseline association between centre-level staff CSPAM scores and patient PAM scores. Secondly, paired univariate and unpaired multivariable linear regression analyses were conducted to compare staff CSPAM scores at baseline and six months. RESULTS 236 PAM questionnaires (mean score = 55.5) and 89 CSPAM questionnaires (median score = 72.6) were analysed at baseline. There was no significant association between centre-level mean CSPAM scores and PAM scores in univariate analyses (P = 0.321). After adjusting for patient-level characteristics, increasing centre-level mean CSPAM score by 1 point resulted in a non-significant 0.3-point increase in PAM score (0.328 (95% CI: -0.157 to 0.812; P = 0.184). Paired (n = 37) and unpaired (n = 174) staff analyses showed a non-significant change in CSPAM scores following the BTSC intervention (mean change in CSPAM score in unpaired analysis = 1.339 (95% CI: -1.945 to 4.623; P = 0.422). CONCLUSIONS Lack of a significant: 1) association between CSPAM and PAM scores and 2) change in CSPAM scores suggest that modifying staff beliefs alone is less likely to influence patient self-management, requiring co-production between patients and staff.
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Affiliation(s)
- Maria Keriakos
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
| | - Sonia Lee
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | | | - Steven Ariss
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
| | - Louese Dunn
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Martin Wilkie
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - James Fotheringham
- School of Health and Related Research, ScHARR, University of Sheffield, Sheffield, England
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
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Helmy NH, Hussein A, Kamal M, Minshawy OE, Wahsh EA. Hemodialysis patients' satisfaction with dialysis care: a cross-sectional prospective study conducted in a non-profitable care facility, Minia Egypt. BMC Nephrol 2022; 23:387. [PMID: 36474164 PMCID: PMC9724252 DOI: 10.1186/s12882-022-03010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The prevalence of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) is increasing continuously as a result of the dramatic growth in the prevalence of two main causes of ESKD which are diabetes mellitus (DM) and hypertension, hence, ESKD represents a global concern. Based on the sixth annual report of the Egyptian society of nephrology, the prevalence of ESKD in Egypt is estimated to be 375 per 1000,000. Meanwhile, other studies estimated the prevalence in El-Minia governorate to be around 308 per 1000,000. Hemodialysis (HD) represents the main modality of Kidney replacement therapy (KRT) for sufferers of ESKD in El-Minia governorate. Patients treated with in-center HD attend dialysis care usually three times per week for several hours each time, hence, their experiences during dialysis care will likely have a major impact on living with chronic illness. Hence, measuring patient satisfaction is very important as it is not only an outcome but also a contributor to other outcomes and objectives, it can provide valuable information about problem areas that can be modified to improve patient experience and outcomes. METHODS A single-center cross-sectional prospective study was conducted in the HD unit, Minia nephrology and urology university hospital. Demographic data were obtained through face-to-face interviews, Patients received a questionnaire to assess satisfaction with medical staff interactions, as well as care before, during, and after dialysis. An observational checklist of healthcare staff and equipment in the dialysis unit was also given to the patients. RESULTS One hundred nineteen patients participated in the study; patients were generally satisfied with the care provided in the dialysis unit (mean = 2.64), patients were most satisfied with aspects of care related to nurses, while they were neutral about aspects related to physicians, and were dissatisfied with nutritional care. CONCLUSION There are multiple problem areas in the HD unit affecting patients' experience, and further improvement in the care provided in the dialysis unit is required.
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Affiliation(s)
- Noha H. Helmy
- grid.411806.a0000 0000 8999 4945Department of clinical pharmacy, Faculty of Pharmacy, Minia University, 61519 Minia, Egypt
| | - Amal Hussein
- grid.411806.a0000 0000 8999 4945Department of clinical pharmacy, Faculty of Pharmacy, Minia University, 61519 Minia, Egypt
| | - Marwa Kamal
- grid.411170.20000 0004 0412 4537Department of clinical pharmacy, Faculty of Pharmacy, Fayoum University, 63514 Fayoum, Egypt
| | - Osama El Minshawy
- grid.411806.a0000 0000 8999 4945Department of Internal Medicine, school of medicine, Minia University, 61519 Minia, Egypt
| | - Engy A. Wahsh
- grid.412319.c0000 0004 1765 2101Department of clinical pharmacy, Faculty of Pharmacy, October 6 University, 12573 Giza, Egypt
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Al Nuairi A, Bermamet H, Abdulla H, Simsekler MCE, Anwar S, Lentine KL. Identifying Patient Satisfaction Determinants in Hemodialysis Settings: A Systematic Review. Healthc Policy 2022; 15:1843-1857. [PMID: 36203651 PMCID: PMC9531609 DOI: 10.2147/rmhp.s372094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patient satisfaction is a measure of care quality that assists providers in determining the effectiveness of their services while meeting patients’ expectations. This study aimed to review existing studies that have focused on patients’ satisfaction determinants in Hemodialysis (HD) settings. Methods Electronic databases (PubMed, ScienceDirect, Scopus, and Google Scholar) were searched from 2000 onwards to identify studies using search terms related to patient satisfaction and hemodialysis centers. Article review was limited to studies written in English. A total of 19 articles were included by following the PRISMA statement. Data were extracted using a structured form and summarized in a tabular format to identify different determinants that showed a relationship with patient satisfaction. Determinants were classified into provider-related determinants and patient-related characteristics. Results Provider-related determinants of patient satisfaction in HD centers include staff, facility, service, and treatment. Patient-related characteristics associated with satisfaction include demographics and health status history. Based on this systematic review, key correlates of patient satisfaction in hemodialysis centers include: staff, facility, service, treatment, patient’s demographics, and health status. Conclusion The findings of this study can help healthcare facilities in taking measures in line with the specified determinants to enhance patient satisfaction and improve the organizational performance of the healthcare centers. It is important to constantly study and improve these determinants based on patient feedback to improve patient satisfaction and quality of care.
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Affiliation(s)
- Arwa Al Nuairi
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Hala Bermamet
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Hind Abdulla
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
| | - Mecit Can Emre Simsekler
- Department of Industrial and Systems Engineering, Khalifa University of Science and Technology, Abu Dhabi, 127788, United Arab Emirates
- Correspondence: Mecit Can Emre Simsekler, Khalifa University of Science and Technology, Department of Industrial and Systems Engineering, P.O. Box 127788, Abu Dhabi, United Arab Emirates, Tel +9712 312 4058, Fax +971 2 447 2442, Email
| | - Siddiq Anwar
- Sheikh Shakhbout Medical City, Abu Dhabi, 10001, United Arab Emirates
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
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Ahmad HA, Thomas D, Alrais M, Burton A, Jagdale R. Shortcoming of Measuring Patient Satisfaction's Association With Anemia-Based Cardiovascular Risk in End-Stage Kidney Disease Patients. Cardiol Res 2022; 12:344-350. [PMID: 34970364 PMCID: PMC8683103 DOI: 10.14740/cr1332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/11/2022] Open
Abstract
Background Patient-reported humanistic outcomes like patient satisfaction are becoming more important in clinical practice, but their use has limitations. Improvements are needed to better demonstrate how patient satisfaction and clinical outcomes are associated. The objective of the study was to observe the correlation between patient’s hemoglobin and patient satisfaction. Methods A cross-sectional study was conducted at a University Hospital hemodialysis unit among end-stage kidney disease (ESKD) patients on maintenance hemodialysis in February and March, 2021. During this time period patient satisfaction was measured using an instrument from the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) study. Spearman’s correlation coefficient was used to find a correlation between patient satisfaction domains and hemoglobin. P value was set at 0.05, and SPSS version 26 was used for the analysis. Results Out of 41 patients studied, their satisfaction on care by interprofessional staff was 77.3%, information received was 68.8%, and effectiveness of care was 71.3% for “very good” and “excellent” responses combined. Out of 40 patients, hemoglobin levels were lower in 17 (42.5%) and higher in seven (17.5%) patients than the optimal range of 10 - 12 g/dL. Spearman’s correlation coefficients were not statistically significant for anemia and any patient satisfaction domain (rs: 0.244, 0.101, 0.048, respectively for the three domains). Spearman’s correlation coefficients were high or moderate between patient satisfaction domains; interprofessional staff with information (rs: 0.745, P value < 0.001) and interprofessional staff with the effectiveness of care (rs: 0.619, P value < 0.001). Information domain had a moderate correlation with the effectiveness of care (rs: 0.527, P value < 0.001). Conclusions No correlation was observed between patient satisfaction with hemoglobin. Although patient satisfaction among hemodialysis patients was mostly “very good” or “excellent”, nearly half of the patients were anemic, and some had higher hemoglobin than the target. Since both of these groups have higher cardiovascular risk this provides an opportunity for the development of patient satisfaction tools with greater sensitivity to awareness of patients’ cardiovascular risk.
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Affiliation(s)
| | - Dixon Thomas
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Maryam Alrais
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Aaron Burton
- School of Pharmacy and Physician Assistant Studies, University of Saint Joseph, West Hartford, CT, USA
| | - Rajaram Jagdale
- Department of Nephrology, Thumbay University Hospital, Ajman, United Arab Emirates
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Thompson S, Schick-Makaroff K, Bello A, Tonelli M, Wiebe N, Buzinski R, Courtney M, Szigety S, Shah N, Bohm C. Voicing Individual Concerns for Engagement in Hemodialysis (VOICE-HD): A Mixed Method, Randomized Pilot Trial of Digital Health in Dialysis Care Delivery. Can J Kidney Health Dis 2021; 8:20543581211032857. [PMID: 34377501 PMCID: PMC8323421 DOI: 10.1177/20543581211032857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/13/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND People receiving in-center hemodialysis (HD) have prioritized the need for more individualized health information and better communication with nephrologists. The most common setting for patient-nephrologist interactions is during the HD treatment, which is a time pressured setting that lacks privacy. OBJECTIVE To facilitate effective communication in the hemodialysis (HD) unit, we evaluated the usability of a web application (web app) from both the patient and physician perspective. The main aim of the web app was to support patients in prioritizing their dialysis concerns outside of the clinical HD encounter. DESIGN Mixed method, parallel arm, multi-site, pilot randomized controlled trial. SETTING Two outpatient Canadian HD centers. PARTICIPANTS Adult patients receiving in-center HD and their attending nephrologists. METHODS Patients were randomized to either a web application or an active control (paper form) for logging concerns to be addressed at weekly encounters with the nephrologist over 8 weeks. Topics included: HD treatment, symptoms, modality, and medications. The primary outcome was usability, defined as effectiveness (engagement with the tool, frequency of submitted concerns, whether the concern was satisfactorily addressed) and satisfaction with the tool using a priori thresholds and explored in interviews with patients and nephrologists. RESULTS 77 patients (30 women, median age 61, interquartile range [53,67], median 2 years [1,4] on dialysis) and 19 nephrologists (4 women, median age 46 [36,65]) were enrolled. Patient use of a digital device at baseline was low (20%). Engagement with the tool was 70% (web app) and 100% (paper) with a lower proportion of patients in the web app group submitting at least one concern over 8 weeks compared to the paper form group: 56.7% vs 87.9%. Weekly concerns were satisfactorily addressed in both groups and ≥70% of patients would continue to use the tools. For patients, both tools promoted preparation and participation in the encounter; however, only the web app facilitated greater privacy in relaying concerns. For most nephrologists, the tools were disruptive to their workflow and were perceived as unnecessary given existing processes and familiarity with patients. For future versions of the app, patients suggested more features to facilitate self-management and nephrologists suggested integration with health databases and multidisciplinary teams. LIMITATIONS Tertiary setting may limit generalizability. CONCLUSIONS Both tools promoted fundamental components of self-management; however, patients in the paper form group submitted concerns more often and this tool was easier to remember to use. Although modifications would likely enhance web app usability, successful future adoption is limited by physician acceptance.Trial registration ClinicalTrials.gov NCT03605875.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Clara Bohm
- Department of Internal Medicine, Health
Sciences, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
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Sutherland S, Durley KE, Gillies K, Glogowska M, Lasserson DS, Pugh C, Lowney AC. 'You see the empty bed which means it's either a transplant or a death': a qualitative study exploring the impact of death in the haemodialysis community. BMJ Open 2021; 11:e046537. [PMID: 34158299 PMCID: PMC8220525 DOI: 10.1136/bmjopen-2020-046537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To explore the impact of the death of a patient in the haemodialysis unit on fellow patients. METHODS We interviewed patients on dialysis in a tertiary dialysis centre using semistructured interviews. We purposively sampled patients who had experienced the death of a fellow patient. After interviews were transcribed, they were thematically analysed by independent members of the research team using inductive analysis. Input from the team during analysis ensured the rigour and quality of the findings. RESULTS 10 participants completed the interviews (6 females and 4 males with an age range of 42-88 years). The four core themes that emerged from the interviews included: (1) patients' relationship to haemodialysis, (2) how patients define the haemodialysis community, (3) patients' views on death and bereavement and (4) patients' expectations around death in the dialysis community. Patients noticed avoidance behaviour by staff in relation to discussing death in the unit and would prefer a culture of open acknowledgement. CONCLUSION Staff acknowledgement of death is of central importance to patients on haemodialysis who feel that the staff are part of their community. This should guide the development of appropriate bereavement support services and a framework that promotes the provision of guidance for staff and patients in this unique clinical setting. However, the authors acknowledge the homogenous sample recruited in a single setting may limit the transferability of the study. Further work is needed to understand diverse patient and nurse experiences and perceptions when sharing the knowledge of a patient's death and how they react to loss.
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Affiliation(s)
- Sheera Sutherland
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kirsty E Durley
- Department of Palliative Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Kirsty Gillies
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Daniel S Lasserson
- Population Evidence and Technologies, Warwick Medical School, University of Warwick, Coventry, UK
| | - Christopher Pugh
- Oxford Kidney Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Aoife C Lowney
- Department of Palliative Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Hazara AM, Bhandari S. Age, Gender and Diabetes as Risk Factors for Early Mortality in Dialysis Patients: A Systematic Review. Clin Med Res 2021; 19:54-63. [PMID: 33582647 PMCID: PMC8231690 DOI: 10.3121/cmr.2020.1541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 10/11/2020] [Accepted: 12/11/2020] [Indexed: 02/07/2023]
Abstract
Objective: To study the impact of age, gender, and presence of diabetes (any type) on the risk of early deaths (180-day mortality) in patients starting long-term hemodialysis (HD) therapy.Design: Systematic review of the literature.Setting: Out-patient (non-hospitalized), community-based HD therapy world-wide.Participants: Patients with advanced chronic kidney disease (CKD) starting long-term HD treatment for end-stage renal disease (ESRD).Methods: Medline and EMBASE were searched for studies published between 1/1/1985 and 12/31/2017. Observational studies involving adult subjects commencing HD were included. Data extracted included population characteristics and settings. In addition, patient or treatment related factors studied with reference to their relationship with the risk of early mortality were documented. The Quality in Prognosis Studies tool was used to assess risk of bias in individual studies. Findings were summarized, and a narrative account was drawn.Results: Included were 26 studies (combined population 1,098,769; representing 287,085 person-years of observation for early mortality). There were 17 cohort and 9 case-control studies. Risk of bias was low in 13 and high in a further 13 studies. Patients who died in the early period were older than those who survived. Mortality rates increased with advancing age. Female gender was associated with slightly increased early mortality rates in larger and higher quality studies. The available data showed conflicting results in relation to the association of diabetes and risk of early mortality.Conclusions: This systematic review evaluated the impact of key demographic and co-morbid factors on risk of early mortality in patients starting maintenance HD. The information could help in delivering more tailored prognostic information and planning of future interventions.
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Affiliation(s)
- Adil M Hazara
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Hull York Medical School, Hull, United Kingdom
| | - Sunil Bhandari
- Department of Renal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Hull York Medical School, Hull, United Kingdom
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Hawkins J, Smeeton N, Busby A, Wellsted D, Rider B, Jones J, Steenkamp R, Stannard C, Gair R, van der Veer SN, Corps C, Farrington K. Contributions of treatment centre and patient characteristics to patient-reported experience of haemodialysis: a national cross-sectional study. BMJ Open 2021; 11:e044984. [PMID: 33853800 PMCID: PMC8054084 DOI: 10.1136/bmjopen-2020-044984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To examine the relative importance of patient and centre level factors in determining self-reported experience of care in patients with advanced kidney disease treated by maintenance haemodialysis (HD). DESIGN Analysis of data from a cross sectional national survey; the UK Renal Registry (UKRR) national Kidney patient-reported experience measure (PREM) survey (2018). Centre-level data were obtained from the UKRR report (2018). SETTING National survey of patients with advanced kidney disease receiving treatment with maintenance HD in UK renal centres in 2018. PARTICIPANTS The Kidney PREM was distributed to all UK renal centres by the UKRR in May 2018. Each centre invited patients receiving outpatient treatment for kidney disease to complete the PREM. These included patients with chronic kidney disease, those receiving dialysis-both HD and peritoneal dialysis, and those with a functioning kidney transplant. There were no formal inclusion/exclusion criteria. MAIN OUTCOME MEASURES The Kidney PREM has 38 questions in 13 subscales. Responses were captured using a 7-point Likert scale (never 1, always 7). The primary outcome of interest was the mean PREM score calculated across all questions. Multilevel modelling was used to determine the proportion of variation of the mean PREM score across centres due to patient-related and centre-related factors. RESULTS There were records for 8253 HD patients (61% men, 77% white) from 69 renal centres (9-710 patients per centre). There was significant variation in mean PREM score across centres (5.35-6.53). In the multivariable analysis there was some variation in relation to both patient- and centre-level factors but these contributed little to explaining the overall variation. However, multilevel modelling showed that the overwhelming proportion of the explained variance (45%) was explained by variation between centres (40%), only a small proportion of which is identified by measured factors. Only 5% of the variation was related to patient-level factors. CONCLUSIONS Centre rather than patient characteristics determine the experience of care of patients receiving HD. Further work is required to define the characteristics of the treating centre which determine patient experience.
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Affiliation(s)
- Janine Hawkins
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Nigel Smeeton
- Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Amanda Busby
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - David Wellsted
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Beth Rider
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Julia Jones
- Health and Social Work, University of Hertfordshire, Hatfield, UK
| | | | | | - Rachel Gair
- UK Renal Registry, Renal Association, Bristol, UK
| | | | - Claire Corps
- St James's University Teaching Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ken Farrington
- Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Renal Unit, Lister Hospital, Stevenage, UK
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Cirillo L, Toccafondi A, Cutruzzulà R, Miraglia Raineri A, Pernazza M, Fiasella S, Dattolo P. Association between Satisfaction with Dialysis Treatment and Quality of Life: A Cross-Sectional Study. Blood Purif 2020; 50:188-195. [PMID: 32846414 DOI: 10.1159/000509787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 06/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION CKD is associated with a reduction of patients' health-related quality of life. Considering the time spent in dialysis, satisfaction with care is essential for patients QOL. OBJECTIVE Since the possible association between satisfaction with the dialysis care and QOL has never been studied, in this study, we explore this plausible link. METHODS One hundred three patients on hemodialysis (HD) and peritoneal dialysis (PD) filled-in patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). QOL was assessed by Kidney Disease Quality of Life-36 and satisfaction by Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) questionnaire. The analysis was conducted on patient-level, considering for single patient sociodemographic characteristics and presence of depression/anxiety. One-way ANOVA was used to compare QOL mean scores for patients who answered "excellent" and for those who answered "other ratings" in CHOICE questionnaire and the Pearson χ2 test to compare the patients' characteristics between these 2 groups of patients. RESULTS The analysis showed a significant positive association between PREM and PROM scores for 8 out of 23 CHOICE items. Six of them were related to the figure of nephrologist, 1 to dialysis access site, and 1 to the social worker support. Significant association (p < 0.05) were between frequency of seeing nephrologist and physical component plus mental component, accuracy of information from nephrologist and burden of disease, accuracy of instructions from nephrologist and burden of disease, coordination between nephrologist and other physicians plus mental component, attention to cleanliness of access site and mental component, amount of dialysis information from staff and burden of disease, information from staff when choosing between HD or PD and physical component plus burden of disease, and ease of seeing social worker and burden of disease. CONCLUSIONS The study provides support for the relationship between the care satisfaction and QOL, highlighting the central role of the nephrologist-patient communication in the QOL of dialysis patients.
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Affiliation(s)
- Luigi Cirillo
- Division of Nephrology and Dialysis, SMA Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Roberta Cutruzzulà
- Division of Nephrology and Dialysis, SMA Hospital, Bagno a Ripoli, Florence, Italy
| | | | - Matteo Pernazza
- Division of Nephrology and Dialysis, SMA Hospital, Bagno a Ripoli, Florence, Italy
| | - Susanna Fiasella
- Division of Nephrology and Dialysis, SMA Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Dattolo
- Division of Nephrology and Dialysis, SMA Hospital, Bagno a Ripoli, Florence, Italy,
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Zhang L, Lee WC, Wu CH, Kuo LC, Yang HT, Moi SH, Yang CH, Chen JB. Importance of non-medical reasons for dropout in patients on peritoneal dialysis. Clin Exp Nephrol 2020; 24:1050-1057. [PMID: 32757098 DOI: 10.1007/s10157-020-01948-y] [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: 05/07/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND To describe the associated factors for non-medical reasons for dropout in peritoneal dialysis (PD) patients. METHODS A retrospective cohort study was performed using registry data of adult patients commencing PD as their initial renal replacement therapy in one hospital-facilitated PD center in Taiwan between 2014 and 2018. The collected data included socio-demographics and relevant medical and PD-related parameters. Kaplan-Meier analysis was used to determine the impact of non-medical reasons and medical reasons on PD dropout. RESULTS The analysis included 224 PD patients, of whom 37 dropped out for non-medical reasons and 187 for medical reasons during the study period. There was significant difference between the two cohorts in age (62.3 years vs. 56.1 years, P = 0.010) and PD vintage (median 3.4 years vs. 4.8 years, P = 0.001). Diabetes was more predominant in the cohort for non-medical reasons than in the one for medical reasons (54.1% vs. 27.3% respectively, P = 0.001). In non-medical reason cohort, two leading reasons given for dropping out were lacking of caregivers (n = 12) and losing confidence (n = 10), whereas PD-related peritonitis (n = 101) was the main medical reason for PD dropout. Using Kaplan-Meier curve analysis, patients in the non-medical reason cohort demonstrated higher cumulative dropout rate compared to patients in the medical reason cohort during a 10-year period (P < 0.001). CONCLUSIONS The main characteristics of PD dropout patients for non-medical reasons are age, diabetes, patients' perception and caregiver support.
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Affiliation(s)
- Lin Zhang
- Division of Nephrology, Department of Internal Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xi Qing District, 88 Chang Ling Rd, Tianjin, China
| | - Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Chien-Hsing Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Li-Chueh Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan
| | - Hong-Tao Yang
- Division of Nephrology, Department of Internal Medicine, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Xi Qing District, 88 Chang Ling Rd, Tianjin, China.
| | - Sin-Hua Moi
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, 84001, Taiwan
| | - Cheng-Hong Yang
- Department of Electronic Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
| | - Jin-Bor Chen
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123 Ta Pei Rd, Kaohsiung, Niao Song District, Taiwan.
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11
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Punj S, Enaam A, Marquez A, Atkinson AJ, Batlle D. A Survey on Dialysis-Related Muscle Cramping and a Hypothesis of Angiotensin II on Its Pathophysiology. Kidney Int Rep 2020; 5:924-926. [PMID: 32518876 PMCID: PMC7270715 DOI: 10.1016/j.ekir.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/06/2020] [Accepted: 03/02/2020] [Indexed: 10/26/2022] Open
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12
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Pharmacist-led Medication Counseling for Patients Undergoing Hemodialysis: A Path to Better Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072399. [PMID: 32244700 PMCID: PMC7177809 DOI: 10.3390/ijerph17072399] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The primary objective was to assess the satisfaction of patients undergoing hemodialysis regarding counseling services provided by pharmacists. The secondary objectives were to compare the effect of years on dialysis and the presence of comorbidities on patient satisfaction. METHODS A total of 138 patients were included in the study, and all demographic and clinical variables were retrieved from the dialysis unit records of King Abdulaziz Medical City over a period of 4 months from July to October 2015. Chi-square test and Fisher's exact test were used for group comparisons at a significance level of 0.05. Results: Most patients aged between 51 and 75 years and had been on dialysis for 1 to 5 years; 94.9% of them had comorbidities. The overall satisfaction of patients toward pharmacy services was excellent (77.5%), and approximately 38.4% of patients thought that pharmacists were providing clear information about their prescribed medications. In addition, 55.8 % of the patients did not know that hemodialysis could affect the efficacy of their medications. Conclusions: Patients undergoing hemodialysis were somewhat satisfied with the counseling provided by the pharmacist. Moreover, there is a need for educational programs for patients undergoing hemodialysis that would increase awareness among hospital pharmacists to improve patients' medication knowledge.
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13
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Delmas P, Antonini M, Berthoud L, O’Reilly L, Cara C, Brousseau S, Bellier‐Teichmann T, Weidmann J, Roulet‐Schwab D, Ledoux I, Pasquier J, Boillat E, Brandalesi V, Konishi M. A comparative descriptive analysis of perceived quality of caring attitudes and behaviours between haemodialysis patients and their nurses. Nurs Open 2020; 7:563-570. [PMID: 32089853 PMCID: PMC7024631 DOI: 10.1002/nop2.421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
Aim Despite its importance in nursing, perceived quality of the nurse-patient relationship has seldom been researched. This study sought to examine and compare the quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses. Design This comparative descriptive study involved 140 haemodialysis patients and 101 nurses caring for them in ten haemodialysis units in the French-speaking part of Switzerland. Methods Participants completed a sociodemographic questionnaire and the Caring Nurse-Patient Interaction Scale (CNPI-70). Results Both nurses and patients reported a high frequency of caring attitudes and behaviours. Patients gave higher ratings than nurses did on all the caring dimensions, except spirituality. Implications are discussed.
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Affiliation(s)
- Philippe Delmas
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Matteo Antonini
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Laurent Berthoud
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | | | | | | | | | - Jean Weidmann
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
| | | | | | - Jérôme Pasquier
- Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| | - Evelyne Boillat
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Vanessa Brandalesi
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Mario Konishi
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
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14
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Romero-Ruiz AB, Sevillano-Jiménez A, Cardador-Trocoli C. Factores asociados a la satisfacción del paciente en diálisis. ENFERMERÍA NEFROLÓGICA 2019. [DOI: 10.4321/s2254-28842019000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La satisfacción del paciente es uno de los grandes retos que persigue conseguir el sistema sanitario y que repercute de forma positiva en la esfera biopsicosocial del paciente.
Constituye una prioridad de los profesionales sanitarios el velar por dicha satisfacción y ello pasa por conocer las necesidades del paciente para luego marcar objetivos que el personal debe cumplir.
Objetivo: Analizar la satisfacción del paciente en diálisis a partir de la producción científica existente.
Material y Método: Se ha realizado una revisión integrativa mediante una búsqueda en las bases de datos Pubmed, Cuiden, Google académico y Medes. Se incluyeron artículos científicos originales y de revisión, en inglés y español, excluyendo aquellos artículos que no presentaban resultados o que no estuviesen en texto completo.
Resultados: Se revisaron 17 artículos que se ajustaron a los criterios de selección. Los principales resultados encontrados se agruparon en los siguientes aspectos: factores determinantes en el nivel de satisfacción del paciente, herramientas de valoración de la satisfacción, rol de enfermería y áreas de mejora.
Conclusiones: Los factores más influyentes en la satisfacción del paciente en diálisis son, principalmente, la confianza transmitida y disposición del personal sanitario, trato personalizado, amabilidad y seguridad transmitida, la destreza para puncionar, entre otros. Respecto a los instrumentos de medida, no existe un instrumento de medida específico, para evaluar la satisfacción del paciente en diálisis. Los atributos más satisfactorios que destacan en la enfermería, son amabilidad, disposición e interés, preparación técnica profesional, trato personalizado, confianza y seguridad clínica.
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15
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Morton RL, Lioufas N, Dansie K, Palmer SC, Jose MD, Raj R, Salmon A, Sypek M, Tong A, Ludlow M, Boudville N, McDonald S. Use of patient-reported outcome measures and patient-reported experience measures in renal units in Australia and New Zealand: A cross-sectional survey study. Nephrology (Carlton) 2019; 25:14-21. [PMID: 30838732 DOI: 10.1111/nep.13577] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2019] [Indexed: 11/29/2022]
Abstract
AIM Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly used in research to quantify how patients feel and function, and their experiences of care, however, knowledge of their utilization in routine nephrology is limited. METHODS The Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) PROMs working group conducted a prospective cross-sectional survey of PROMs/PREMs use among renal 'parent hospitals'. One survey per hospital was completed (August-November 2017). Descriptive statistics reported type and frequency of measures used and purpose of use. RESULTS Survey response rate was 100%. Fifty-five of 79 hospitals (70%) used at least one PROMs or PREMs for specific patient groups. PROMs were more likely to be collected from patients receiving comprehensive conservative care (45% of hospitals) than dialysis patients (32%, 31% and 28% of hospitals for home haemodialysis, peritoneal dialysis and facility dialysis, respectively). Few renal transplanting hospitals (3%) collected PROMs. The Integrated Palliative Outcome Scale-Renal (IPOS-Renal) (40% of units), and the Euro-Qol (EQ-5D-5 L) (25%), were most frequently used. The main reason for collecting PROMs was to inform clinical care (58%), and for PREMs was to fulfil private dialysis/hospital provider requirements (25%). The most commonly reported reason for not using PROMs in 24 hospitals was insufficient staff resources (79%). Sixty-two hospitals (78%) expressed interest in participating in a registry-based PROMs trial. CONCLUSION Many renal hospitals in Australia and New Zealand collect PROMs and/or PREMs as part of clinical care with use varying by treatment modality. Resources are a key barrier to PROMs use.
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Affiliation(s)
- Rachael L Morton
- NHMRC Clinical Trials Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicole Lioufas
- Department of Nephrology, Western Health, Sunshine Hospital, Melbourne, Victoria, Australia.,Western Clinical School, School of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | | | - Matthew D Jose
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rajesh Raj
- Launceston General Hospital, Launceston, Tasmania, Australia
| | - Andrew Salmon
- Renal Service, Waitemata District Health Board, Auckland, New Zealand
| | - Matthew Sypek
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia.,Department of Nephrology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Allison Tong
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Central and Northern Renal Transplant Service, Royal Adelaide Hospital, Adelaide, Australia
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16
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Dad T, Tighiouart H, Lacson E, Meyer KB, Weiner DE, Richardson MM. Hemodialysis patient characteristics associated with better experience as measured by the In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. BMC Nephrol 2018; 19:340. [PMID: 30486811 PMCID: PMC6264620 DOI: 10.1186/s12882-018-1147-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/21/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patient experience in hemodialysis (HD) is measured twice yearly in all in-center HD patients in the United States using the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. Survey scores are publically available and incorporated into the dialysis payment system. Despite its importance, little is known about factors associated with better experience scores. We studied the association between patient-level characteristics and experience scores in a large real-world cohort of HD patients. METHODS This is a cross-sectional analysis of ICH CAHPS administration in 2012. All in-center HD patients in Dialysis Clinic, Incorporated facilities nationally over 18 years old and receiving HD at their facility for at least 3 months were eligible. Predictors include patient demographic, clinical, and treatment-related characteristics. Outcomes include high global rating scores across three domains (Nephrologist, Dialysis Staff, Dialysis Center) and high composite scores across three domains (Nephrologists' Communication and Caring, Quality of Dialysis Center Care and Operations, and Providing Information to Patients). RESULTS Among 3369 respondents, older age and telephone (vs. mail) administration of the survey were associated with higher global ratings, while shortened HD treatments were associated with lower global ratings. Lower education and telephone administration were associated with higher composite scores, while older age, and shortened HD treatments were associated with lower composite scores. CONCLUSIONS Several patient characteristics and mode of survey administration are associated with higher experience scores. Future research should assess HD facility characteristics associated with higher scores and interventions that might improve experience accounting for these associations.
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Affiliation(s)
- Taimur Dad
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, USA
| | - Hocine Tighiouart
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA USA
- Biostatistics, Epidemiology and Research Design (BERD) Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA USA
| | - Eduardo Lacson
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
- Dialysis Clinic Incorporated, Nashville, TN USA
| | - Klemens B. Meyer
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
| | - Daniel E. Weiner
- Tufts Medical Center, 800 Washington Street Box 391, Boston, MA 02111 USA
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17
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Robinski M, Mau W, Wienke A, Girndt M. The Choice of Renal Replacement Therapy (CORETH) project: dialysis patients' psychosocial characteristics and treatment satisfaction. Nephrol Dial Transplant 2018; 32:315-324. [PMID: 28186578 DOI: 10.1093/ndt/gfv464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/25/2015] [Indexed: 11/13/2022] Open
Abstract
Background Until today, research has underestimated the role of psychosocial conditions as contributing factors to dialysis modality choice. The novelty within the Choice of Renal Replacement Therapy (CORETH) project (German Clinical Trials Register #DRKS00006350) is its focus on the multivariate associations between these aspects and their consecutive significance regarding treatment satisfaction (TS) in peritoneal dialysis (PD) versus haemodialysis (HD) patients. In this article, we present the baseline results of a multicentre study, which is supported by a grant from the German Ministry for Education and Research. Methods Six to 24 months after initiation of dialysis, 780 patients from 55 dialysis centres all over Germany were surveyed. The questionnaire addressed psychosocial, physical, socio-demographic and shared decision-making (SDM) aspects. Furthermore, cognitive functioning was tested. After indexing the measures, two propensity score-matched groups (n = 482) were compared in a first step, after having chosen PD or HD. In a second step, a moderated multiple regression (n = 445) was conducted to initially investigate the multivariate impact of patient characteristics on TS. Results In comparison with HD patients, PD patients were more satisfied with their treatment (P < 0.001), had a more autonomy-seeking personality (P = 0.04), had better cognitive functioning (P = 0.001), indicated more satisfying SDM (P < 0.001) and had a larger living space (P < 0.001). All patients were more satisfied when they had a good psychological state and received SDM. Especially in HD patients, TS was higher when the patient had a less autonomous personality, lower cognitive functioning, more social support, a poorer physical state and poorer socio-demographic conditions (R2 = 0.26). Conclusions Psychosocial characteristics play a major role in TS in dialysis patients. Within a multivariate approach, these factors are even more important than physical or environment-related factors. In practice, focusing on SDM and screening patient characteristics at an early stage can foster patients’ TS. Changes will be examined in a 1-year follow-up.
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Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Internal Medicine II, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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18
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Stavropoulou A, Grammatikopoulou MG, Rovithis M, Kyriakidi K, Pylarinou A, Markaki AG. Through the Patients' Eyes: The Experience of End-Stage Renal Disease Patients Concerning the Provided Nursing Care. Healthcare (Basel) 2017; 5:healthcare5030036. [PMID: 28754014 PMCID: PMC5618164 DOI: 10.3390/healthcare5030036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 11/21/2022] Open
Abstract
Chronic kidney disease is a condition that affects both the physical and mental abilities of patients. Nursing care is of pivotal importance, in particular when end-stage renal disease (ESRD) patients are concerned, since the quality of the provided care may severely influence the patient’s quality of life. This is why it is important to explore patient experiences concerning the rendered care. However, limited up-to-date studies have addressed this issue. The aim of the present study was to stress the experiences of ESRD patients concerning the provided nursing care in the hemodialysis unit at the University Hospital in Heraklion, Crete. A qualitative methodological approach was used, based on the principles of phenomenological epistemology. Semi-structured interviews were conducted, and open-ended questions were applied to record how patients experienced the rendered care during dialysis. The recorded data were analyzed via qualitative content analysis, which revealed three main themes: ‘Physical Care’, ‘Psychological Support’ and ‘Education’. Patients’ views were conceptualized into sub-themes within each main theme. The interviews revealed the varied and distinct views of ESRD patients, indicating that the rendered care should be individualized.
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Affiliation(s)
- Areti Stavropoulou
- Department of Nursing, Technological Educational Institute of Crete, Estavromenos, Irakleio, 71004, Greece.
| | - Maria G Grammatikopoulou
- Department of Nutrition & Dietetics, Alexander Technological Educational Institute, Sindos 574 00, Greece.
| | - Michail Rovithis
- Department of Nursing, Technological Educational Institute of Crete, Estavromenos, Irakleio, 71004, Greece.
| | - Konstantina Kyriakidi
- Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Estavromenos, Irakleio, 71004, Greece.
| | - Andriani Pylarinou
- Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Estavromenos, Irakleio, 71004, Greece.
| | - Anastasia G Markaki
- Department of Nutrition & Dietetics, Technological Educational Institute of Crete, Estavromenos, Irakleio, 71004, Greece.
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19
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Reid C, Seymour J, Jones C. A Thematic Synthesis of the Experiences of Adults Living with Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1206-1218. [PMID: 27246010 PMCID: PMC4934845 DOI: 10.2215/cjn.10561015] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 03/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients on in-center dialysis spend significant amounts of time in the dialysis unit; additionally, managing ESRD affects many aspects of life outside the dialysis unit. To improve the care provided to patients requiring hemodialysis, their experiences and beliefs regarding treatment must be understood. This systematic review aimed to synthesize the experiences of patients receiving in-center hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched Embase, MEDLINE, CINAHL, PsychINFO, Google Scholar, and reference lists for primary qualitative studies published from 1995 to 2015 that explored the experiences of adult patients receiving treatment with in-center hemodialysis. A thematic synthesis was conducted. RESULTS Seventeen studies involving 576 patients were included in the synthesis. Four analytic themes were developed. The first theme (a new dialysis-dependent self) describes the changes in identity and perceptions of self that could result from dialysis dependence. The second theme (a restricted life) describes the physical and emotional constraints that patients described as a consequence of their dependence. Some patients reported strategies that allowed them to regain a sense of optimism and influence over the future, and these contributed to the third theme (regaining control). The first three themes describe a potential for change through acceptance, adaption, and regaining a sense of control. The final theme (relationships with health professionals) describes the importance of these relationships for in-center patients and their influence on perceptions of power and support. These relationships are seen to influence the other three themes through information sharing, continuity, and personalized support. CONCLUSIONS Our synthesis has resulted in a framework that can be used to consider interventions to improve patients' experiences of in-center hemodialysis care. Focusing on interventions that are incorporated into the established relationships that patients have with their health care professionals may enable patients to progress toward a sense of control and improve satisfaction with care.
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Affiliation(s)
- Claire Reid
- Supportive Care, Early Diagnosis and Advanced Disease Research Group, Hull York Medical School, University of York, York, United Kingdom; and
| | - Julie Seymour
- Supportive Care, Early Diagnosis and Advanced Disease Research Group, Hull York Medical School, University of York, York, United Kingdom; and
| | - Colin Jones
- York Hospitals National Health Service Trust
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20
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Lok CE, Perazella MA, Choi MJ. American Society of Nephrology Quiz and Questionnaire 2015: ESRD/RRT. Clin J Am Soc Nephrol 2016; 11:1313-1320. [PMID: 27094608 PMCID: PMC4934831 DOI: 10.2215/cjn.01280216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
The Nephrology Quiz and Questionnaire remains an extremely popular session for attendees of the Annual Kidney Week Meeting of the American Society of Nephrology. During the 2015 meeting, the conference hall was once again overflowing with eager quiz participants. Topics covered by the experts included electrolyte and acid-base disorders, glomerular disease, ESRD and dialysis, and kidney transplantation. Complex cases representing each of these categories together with single best answer questions were prepared and submitted by the panel of experts. Before the meeting, training program directors of nephrology fellowship programs and nephrology fellows in the United States answered the questions through an internet-based questionnaire. During the live session, members of the audience tested their knowledge and judgment on the same series of case-oriented questions in a quiz. The audience compared their answers in real time using a cellphone application containing the answers of the nephrology fellows and training program directors. The results of the online questionnaire were displayed, and then, the quiz answers were discussed. As always, the audience, lecturers, and moderators enjoyed this highly educational session. This article recapitulates the session and reproduces selected content of educational value for the readers of the Clinical Journal of the American Society of Nephrology Enjoy the clinical cases and expert discussions.
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Affiliation(s)
- Charmaine E. Lok
- Division of Nephrology, Department of Medicine, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Mark A. Perazella
- Section of Nephrology, Yale University School of Medicine, New Haven, Connecticut; and
| | - Michael J. Choi
- Division of Nephrology, Johns Hopkins University, Baltimore, Maryland
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21
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Phirtskhalaishvili T, Bayer F, Edet S, Bongiovanni I, Hogan J, Couchoud C. Spatial Analysis of Case-Mix and Dialysis Modality Associations. Perit Dial Int 2016; 36:326-33. [PMID: 26475843 PMCID: PMC4881796 DOI: 10.3747/pdi.2015.00003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/21/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Health-care systems must attempt to provide appropriate, high-quality, and economically sustainable care that meets the needs and choices of patients with end-stage renal disease (ESRD). France offers 9 different modalities of dialysis, each characterized by dialysis technique, the extent of professional assistance, and the treatment site. The aim of this study was 1) to describe the various dialysis modalities in France and the patient characteristics associated with each of them, and 2) to analyze their regional patterns to identify possible unexpected associations between case-mixes and dialysis modalities. ♦ METHODS The clinical characteristics of the 37,421 adult patients treated by dialysis were described according to their treatment modality. Agglomerative hierarchical cluster analysis was used to aggregate the regions into clusters according to their use of these modalities and the characteristics of their patients. ♦ RESULT The gradient of patient characteristics was similar from home hemodialyis (HD) to in-center HD and from non-assisted automated peritoneal dialysis (APD) to assisted continuous ambulatory peritoneal dialysis (CAPD). Analyzing their spatial distribution, we found differences in the patient case-mix on dialysis across regions but also differences in the health-care provided for them. The classification of the regions into 6 different clusters allowed us to detect some unexpected associations between case-mixes and treatment modalities. ♦ CONCLUSIONS The 9 modalities of treatment available make it theoretically possible to adapt treatment to patients' clinical characteristics and abilities. However, although we found an overall appropriate association of dialysis modalities to the case-mix, major inter-region heterogeneity and the low rate of peritoneal dialysis (PD) and home HD suggest that factors besides patients' clinical conditions impact the choice of dialysis modality. The French organization should now be evaluated in terms of patients' quality of life, satisfaction, survival, and global efficiency.
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Affiliation(s)
- Tamar Phirtskhalaishvili
- REIN registry, Agence de la biomédecine, France Children's Medical Centre "Mrcheveli," Tbilissi, Georgia
| | | | | | - Isabelle Bongiovanni
- Department of Economic Evaluation and Public Health, Haute Autorité de Santé, France
| | - Julien Hogan
- REIN registry, Agence de la biomédecine, France Nephrology Unit, Robert Debré, University Hospital, Paris, France
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22
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Robinski M, Mau W, Wienke A, Girndt M. Shared decision-making in chronic kidney disease: A retrospection of recently initiated dialysis patients in Germany. PATIENT EDUCATION AND COUNSELING 2016; 99:562-570. [PMID: 26527307 DOI: 10.1016/j.pec.2015.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/25/2015] [Accepted: 10/17/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare differences in shared decision-making (SDM) and treatment satisfaction (TS) between haemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS 6-24 months after initiation of dialysis, we surveyed 780 patients from throughout Germany (CORETH-project) regarding SDM, the reason for modality choice and TS. Data were compared between two age-, comorbidity-, education-, and employment status-matched groups (n=482). RESULTS PD patients rated all aspects of SDM more positively than did HD patients (total score: MPD=84.6, SD=24.1 vs. MHD=61.9, SD=37.3; p≤0.0001). The highest difference occurred for the item "announcement of a necessary decision" (delta=1.3 points on a 6-point Likert-scale). PD patients indicated their desire for independence as a motivator for choosing PD (65%), whereas HD patients were subject to medical decisions (23%) or wanted to rely on medical support (20%). We found positive correlations between SDM and TS (0.16≤r≤0.48; p≤0.0001). CONCLUSION Our findings increase awareness of a participatory nephrological counseling-culture and imply that SDM can pave the way for quality of life and treatment success for dialysis patients. PRACTICE IMPLICATIONS Practitioners can facilitate SDM by screening patient preferences at an early stage, being aware of biases in consultation, using easy terminology and encouraging passive patients to participate in the choice.
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Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Department of Internal Medicine II, University Hospital of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Chen SS, Unruh M, Williams M. In Quality We Trust; but Quality of Life or Quality of Care? Semin Dial 2016; 29:103-10. [PMID: 26860436 DOI: 10.1111/sdi.12470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The ESRD program provides medical care to a diverse and medically complex patient population. The care for the ESRD patient population has become increasingly benchmarked with process of care measures. These measures include dialysis adequacy, anemia, nutrition, and vascular access outcomes. These process-related dialysis measures may not improve the care of the individual patient as care relates to the individual's goals and values. There is also evidence that these process measures may not be causally related to quality of life, hospitalization, and survival. The adoption of patient-reported outcomes may shift the balance toward more patient-centered care. However, the extent to which mandated measures of health-related quality of life and patient satisfaction result in improved outcomes remains unclear.
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Affiliation(s)
- Shan Shan Chen
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Mark Unruh
- Nephrology Division, Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico.,Renal Section, Medicine Service, Department of Medicine, Raymond G. Murphy VA Medical Center, School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Mark Williams
- Nephrology Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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24
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Breckenridge K, Bekker HL, Gibbons E, van der Veer SN, Abbott D, Briançon S, Cullen R, Garneata L, Jager KJ, Lønning K, Metcalfe W, Morton RL, Murtagh FE, Prutz K, Robertson S, Rychlik I, Schon S, Sharp L, Speyer E, Tentori F, Caskey FJ. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting. Nephrol Dial Transplant 2015; 30:1605-14. [PMID: 25982327 PMCID: PMC4569391 DOI: 10.1093/ndt/gfv209] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/13/2015] [Indexed: 11/14/2022] Open
Abstract
Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF-12, the disease-specific KDQOL™-36 and EQ-5D-5L to be able to derive quality-adjusted life years), but further work was felt to be needed before recommending PREMs. Routinely collecting PROMs and PREMs in renal registries is important if we are to better understand what matters to patients but it is likely to be challenging; close international collaboration will be beneficial.
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Affiliation(s)
| | - Hillary L. Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sabine N. van der Veer
- European Renal Best Practice, Methods Support Team, University Hospital Ghent, Ghent, Belgium
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK
| | - Denise Abbott
- The National Kidney Federation, Shireoaks, Worksop, UK
| | - Serge Briançon
- CHU de Nancy, Epidémiologie et évaluation cliniques, Inserm CIC 1433, Nancy, France
| | - Ron Cullen
- UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Liliana Garneata
- ‘Dr Carol Davila’ Teaching Hospital of Nephrology, Bucharest, Romania
| | - Kitty J. Jager
- European Renal Association–European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kjersti Lønning
- Section of Nephrology, Department of Organ Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Wendy Metcalfe
- Renal Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- The Scottish Renal Registry, Glasgow, UK
| | - Rachael L. Morton
- School of Public Health, The University of Sydney, Sydney, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Headington, UK
| | - Fliss E.M. Murtagh
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karl Prutz
- Swedish Renal Registry, Jönköping, Sweden
- Department of Internal Medicine, Hospital of Helsingborg, Helsingborg, Sweden
| | | | - Ivan Rychlik
- 2nd Department of Medicine, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steffan Schon
- Swedish Renal Registry, Jönköping, Sweden
- Diaverum Renal Services Group, Lund, Sweden
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland
| | - Elodie Speyer
- CHU Nancy, Pôle QSP2, Epidémiologie et Evaluation Cliniques, Nancy, France
- Université de Lorraine, Université Paris Descartes, Nancy, France
| | | | - Fergus J. Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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25
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Janssen IM, Gerhardus A, von Gersdorff GD, Baldamus CA, Schaller M, Barth C, Scheibler F. Preferences of patients undergoing hemodialysis - results from a questionnaire-based study with 4,518 patients. Patient Prefer Adherence 2015; 9:847-55. [PMID: 26170634 PMCID: PMC4492657 DOI: 10.2147/ppa.s79559] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V) can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients. PATIENTS AND METHODS Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann-Whitney U or Kruskal-Wallis tests. RESULTS Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis duration, and the improvement or preservation of a good emotional state. Age, profession, and education had the strongest influence on relevant differences of preferences for outcomes; no relevant influence of sex or comorbidity was observed. CONCLUSION Outcomes concerning the delivery or provision of care and aspects influencing quality of life are rated by patients to be at least as important as clinical outcomes. Many of the outcomes judged to be important by the patients are not regularly considered in research, evaluation studies, or quality programs.
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Affiliation(s)
- Inger Miriam Janssen
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - Ansgar Gerhardus
- Department for Health Services Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Gero D von Gersdorff
- Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany
| | | | - Mathias Schaller
- Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany
| | - Claudia Barth
- KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., NeuIsenburg, Germany
| | - Fueloep Scheibler
- Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany
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26
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Moledina DG, Perry Wilson F. Pharmacologic Treatment of Common Symptoms in Dialysis Patients: A Narrative Review. Semin Dial 2015; 28:377-83. [DOI: 10.1111/sdi.12378] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Dennis G. Moledina
- Section of Nephrology; Yale University School of Medicine; New Haven Connecticut
- Section of Nephrology; West Haven VA Medical Center; West Haven Connecticut
| | - Francis Perry Wilson
- Section of Nephrology; Yale University School of Medicine; New Haven Connecticut
- Yale Program of Applied Translational Research; New Haven Connecticut
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