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Hughes A, Guha C, Sluiter A, Himmelfarb J, Jauré A. Patient-Centered Research and Innovation in Nephrology. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:52-67. [PMID: 38403395 DOI: 10.1053/j.akdh.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/07/2023] [Accepted: 12/11/2023] [Indexed: 02/27/2024]
Abstract
Patient involvement in research can improve the relevance of research, consequently enhancing the recruitment, retention, and uptake of interventions and policies impacting patient outcomes. Despite this, patients are not often involved in the design and conduct of research. The research agenda and innovations are frequently determined by the interest of health and industry professionals rather than proactively aligning with the priorities of patients. It is now being encouraged and recommended to engage patients in research priority setting to ensure interventions and trials report outcomes valuable to patients, moving away from a history of overlooking the outcomes that reflect the feel and function of patients. Involving patients ensures constant innovative research in nephrology, as this broader depth of evidence fortifies reliability and validity through knowledge gained from lived experience. Findings from such research can enhance clinical practice and strengthen decision-making and policy to support better outcomes. We aim to outline principles and strategies for patient involvement in research, including setting research priorities, identifying and designing interventions, selecting outcomes, and disseminating and translating research. Principles and strategies including engagement, education and training, empowerment, and connection and community provide guidance in patient involvement. There are increasing efforts to involve patients across all stages of research including setting research priorities. Efforts are rising to involve patients across all stages of research including priority setting, identifying and designing interventions, selecting outcomes, and dissemination and translation. Patient involvement throughout the research cycle drives innovative investigations ensuring funding, efforts, and resources are directed toward priorities of patients, contributing to catalyst advancements in care and outcomes.
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Affiliation(s)
- Anastasia Hughes
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Amanda Sluiter
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
| | - Jonathan Himmelfarb
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington; Kidney Research Institute, Seattle, WA
| | - Allison Jauré
- Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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2
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Escoto M, Issa F, Cayouette F, Consolo H, Chaudhury P, Dhanani S, Jiang W, Oniscu GC, Murphy N, Rockell K, Weiss MJ, Dieudé M. Research and Innovation in Organ Donation: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1446. [PMID: 37138559 PMCID: PMC10150888 DOI: 10.1097/txd.0000000000001446] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 12/19/2022] [Accepted: 01/03/2023] [Indexed: 05/05/2023] Open
Abstract
This report provides recommendations from the Research and Innovation domain as part of the International Donation and Transplantation Legislative and Policy Forum (hereafter the Forum) to provide expert guidance on the structure of an ideal organ and tissue donation and transplantation system. The recommendations focus on deceased donation research and are intended for clinicians, investigators, decision-makers, and patient, family, and donor (PFD) partners involved in the field. Methods We identified topics impacting donation research through consensus using nominal group technique. Members performed narrative reviews and synthesized current knowledge on each topic, which included academic articles, policy documents, and gray literature. Using the nominal group technique, committee members discussed significant findings, which provided evidence for our recommendations. The Forum's scientific committee then vetted recommendations. Results We developed 16 recommendations in 3 key areas to provide stakeholders guidance in developing a robust deceased donor research framework. These include PFD and public involvement in research; donor, surrogate, and recipient consent within a research ethics framework; and data management. We highlight the importance of PFD and public partner involvement in research, we define the minimum ethical requirements for the protection of donors and recipients of both target and nontarget organ recipients, and we recommend the creation of a centrally administered donor research oversight committee, a single specialist institutional review board, and a research oversight body to facilitate coordination and ethical oversight of organ donor intervention research. Conclusions Our recommendations provide a roadmap for developing and implementing an ethical deceased donation research framework that continually builds public trust. Although these recommendations can be applied to jurisdictions developing or reforming their organ and tissue donation and transplantation system, stakeholders are encouraged to collaborate and respond to their specific jurisdictional needs related to organ and tissue shortages.
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Affiliation(s)
- Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Fadi Issa
- Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, United Kingdom
| | - Florence Cayouette
- Pediatric Intensive Care Unit, Great Ormond Street Hospital, London, United Kingdom
| | | | - Prosanto Chaudhury
- Transplant Québec, Montréal, QC, Canada
- McGill University Health Centre, Montréal, QC, Canada
| | - Sonny Dhanani
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Children’s Hospital of Eastern Ontario, University of Ottawa, Canada
| | - Wenshi Jiang
- Shanxi Provincial Organ Procurement and Allocation Center, People’s Republic of China
| | - Gabriel C. Oniscu
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, United Kingdom
| | - Nicholas Murphy
- Departments of Medicine and Philosophy, Western University, Canada
| | - Karen Rockell
- Liver Transplant Recipient/Co-Director and PPIE Lead, United Kingdom Organ Donation and Transplantation Research Network, Peterborough, Cambridgeshire, United Kingdom
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
| | - Mélanie Dieudé
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Microbiology, Infectiology and Immunology, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Hema-Quebec, Québec, QC, Canada
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3
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Reddy YNV, Mendu ML, Weinhandl ED. Funding Innovative Dialysis Technology in the United States: Home Dialysis and the ESRD Transitional Add-on Payment for New and Innovative Equipment and Supplies (TPNIES). Am J Kidney Dis 2021; 78:892-896. [PMID: 34051309 PMCID: PMC8608674 DOI: 10.1053/j.ajkd.2021.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 03/15/2021] [Indexed: 11/11/2022]
Abstract
Innovative, patient-centered, and pragmatic dialysis technologies are urgently needed to accommodate the growing national interest in home dialysis use. To help achieve this goal, the US Centers for Medicare & Medicaid Services (CMS) are expanding reimbursement for eligible home dialysis machines through an existing payment mechanism, the transitional add-on payment for new and innovative equipment and supplies (TPNIES). This mechanism incentivizes the early adoption of innovative equipment into practice by reimbursing dialysis providers up to 26% of the total cost of approved home dialysis machines. Machines are evaluated for TPNIES eligibility using prespecified substantial clinical improvement (SCI) criteria that are derived from the Inpatient Prospective Payment System (for non-nephrology technologies). Although the SCI criteria may be suitable for some non-nephrology technologies, they have not been adapted to consider the unique and complex care inherent in home dialysis. Thus, many of the SCI criteria appear unsuitable for home dialysis machines. To better incentivize innovation, CMS should develop nephrology-specific transparent and pragmatic criteria for TPNIES. In this perspective, we provide an overview of the TPNIES payment mechanism, highlight areas of concern within the policy, and offer solutions for improving TPNIES that could better promote the adoption of new home dialysis machines.
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Affiliation(s)
- Yuvaram N V Reddy
- Nephrology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts.
| | - Mallika L Mendu
- Nephrology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Eric D Weinhandl
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
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4
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Ferreira da Silva P, Talson MD, Finlay J, Rossum K, Soroka KV, McCormick M, Desjarlais A, Vorster H, Fontaine G, Sass R, James M, Sood MM, Tong A, Pannu N, Tennankore K, Thompson S, Tonelli M, Bohm C. Patient, Caregiver, and Provider Perspectives on Improving Information Delivery in Hemodialysis: A Qualitative Study. Can J Kidney Health Dis 2021; 8:20543581211046078. [PMID: 34721884 PMCID: PMC8552378 DOI: 10.1177/20543581211046078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Background Patients with kidney failure are exposed to a surfeit of new information about their disease and treatment, often resulting in ineffective communication between patients and providers. Improving the amount, timing, and individualization of information received has been identified as a priority in in-center hemodialysis care. Objective To describe and explicate patient, caregiver, and health care provider perspectives regarding challenges and solutions to information transfer in clinical hemodialysis care. Design In this multicenter qualitative study, we gathered perspectives of patients, their caregivers, and health care providers conducted through focus groups and interviews. Setting Five Canadian hemodialysis centers: Calgary, Edmonton, Winnipeg, Ottawa, and Halifax. Participants English-speaking adults receiving in-center hemodialysis for longer than 6 months, their caregivers, and hemodialysis health care providers. Methods Between May 24, 2017, and August 16, 2018, data collected through focus groups and interviews with hemodialysis patients and their caregivers subsequently informed semi-structured interviews with health care providers. For this secondary analysis, data were analyzed through an inductive thematic analysis using grounded theory, to examine the data more deeply for overarching themes. Results Among 82 patients/caregivers and 31 healthcare providers, 6 main themes emerged. Themes identified from patients/caregivers were (1) overwhelmed at initiation of hemodialysis care, (2) need for peer support, and (3) improving comprehension of hemodialysis processes. Themes identified from providers were (1) time constraints with patients, (2) relevance of information provided, and (3) technological innovations to improve patient engagement. Limitations Findings were limited to Canadian context, English speakers, and individuals receiving hemodialysis in urban centers. Conclusions Participants identified challenges and potential solutions to improve the amount, timing, and individualization of information provided regarding in-center hemodialysis care, which included peer support, technological innovations, and improved knowledge translation activities. Findings may inform the development of interventions and strategies aimed at improving information delivery to facilitate patient-centered hemodialysis care.
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Affiliation(s)
| | - Melanie D Talson
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Juli Finlay
- Cumming School of Medicine, University of Calgary, AB, Canada
| | - Krista Rossum
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | | | - Arlene Desjarlais
- Can-SOLVE CKD Network Patient Council, Canada.,Can-SOLVE CKD Network Indigenous Peoples' Engagement and Research Council, Winnipeg, MB, Canada
| | | | - George Fontaine
- Can-SOLVE CKD Network Patient Council, Canada.,Can-SOLVE CKD Network Indigenous Peoples' Engagement and Research Council, Winnipeg, MB, Canada
| | - Rachelle Sass
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, AB, Canada
| | - Manish M Sood
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, NSW, Australia
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | - Clara Bohm
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, MB, Canada
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5
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Gutman T, Tong A, Howell M, Dansie K, Hawley CM, Craig JC, Jesudason S, Chapman JR, Johnson DW, Murphy L, Reidlinger D, Crowe S, Duncanson E, Muthuramalingam S, Scholes-Robertson N, Williamson A, McDonald S. Principles and strategies for involving patients in research in chronic kidney disease: report from national workshops. Nephrol Dial Transplant 2021; 35:1585-1594. [PMID: 31093667 DOI: 10.1093/ndt/gfz076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/15/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is widespread recognition that research will be more impactful if it arises from partnerships between patients and researchers, but evidence on best practice for achieving this remains limited. METHODS We convened workshops in three Australian cities involving 105 patients/caregivers and 43 clinicians/researchers. In facilitated breakout groups, participants discussed principles and strategies for effective patient involvement in chronic kidney disease research. Transcripts were analysed thematically. RESULTS Five major themes emerged. 'Respecting consumer expertise and commitment' involved valuing unique and diverse experiential knowledge, clarifying expectations and responsibilities, equipping for meaningful involvement and keeping patients 'in the loop'. 'Attuning to individual context' required a preference-based multipronged approach to engagement, reducing the burden of involvement and being sensitive to the patient journey. 'Harnessing existing relationships and infrastructure' meant partnering with trusted clinicians, increasing research exposure in clinical settings, mentoring patient to patient and extending reach through established networks. 'Developing a coordinated approach' enabled power in the collective and united voice, a systematic approach for equitable inclusion and streamlining access to opportunities and trustworthy information. 'Fostering a patient-centred culture' encompassed building a community, facilitating knowledge exchange and translation, empowering health ownership, providing an opportunity to give back and cultivating trust through transparency. CONCLUSIONS Partnering with patients in research requires respect and recognition of their unique, diverse and complementary experiential expertise. Establishing a supportive, respectful research culture, responding to their individual context, coordinating existing infrastructure and centralizing the flow of information may facilitate patient involvement as active partners in research.
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Affiliation(s)
- Talia Gutman
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, SA, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service and Royal Adelaide Hospital, Adelaide, SA, Australia.,Kidney Health Australia, Melbourne, SA, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jeremy R Chapman
- Westmead Clinical School, Westmead Institute for Medical Research, NSW, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Lisa Murphy
- Kidney Health Australia, Melbourne, SA, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, Brisbane, QLD, Australia.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | | | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Nicole Scholes-Robertson
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,BEAT-CKD Consumer Advisory Board, BEAT-CKD, SA, Australia
| | - Amber Williamson
- BEAT-CKD Consumer Advisory Board, BEAT-CKD, SA, Australia.,Queensland Consumer Consultative Committee, Kidney Health Australia, Brisbane, QLD, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, SA, Australia.,College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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6
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Natale P, Gutman T, Howell M, Dansie K, Hawley CM, Cho Y, Viecelli AK, Craig JC, Jesudason S, Chapman JR, Johnson DW, Murphy L, Reidlinger D, Crowe S, Duncanson E, Muthuramalingam S, Scholes-Robertson N, Williamson A, McDonald S, Wong G, Teixeira-Pinto A, Strippoli GFM, Tong A. Recruitment and retention in clinical trials in chronic kidney disease: report from national workshops with patients, caregivers and health professionals. Nephrol Dial Transplant 2020; 35:755-764. [PMID: 32240311 DOI: 10.1093/ndt/gfaa044] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Slow recruitment and poor retention jeopardize the reliability and statistical power of clinical trials, delaying access to effective interventions and increasing costs, as commonly observed in nephrology trials. Involving patients in trial design, recruitment and retention is infrequent but potentially transformational. METHODS We conducted three workshops involving 105 patients/caregivers and 43 health professionals discussing patient recruitment and retention in clinical trials in chronic kidney disease. RESULTS We identified four themes. 'Navigating the unknown'-patients described being unaware of the research question, confused by technical terms, sceptical about findings and feared the risk of harm. 'Wary of added burden'-patients voiced reluctance to attend additional appointments, were unsure of the commitment required or at times felt too unwell and without capacity to participate. 'Disillusioned and disconnected'-some patients felt they were taken for granted, particularly if they did not receive trial results. Participants believed there was no culture of trial participation in kidney disease and an overall lack of awareness about opportunities to participate. To improve recruitment and retention, participants addressed 'Building motivation and interest'. CONCLUSIONS Investigators should establish research consciousness from the time of diagnosis, consider optimal timing for approaching patients, provide comprehensive information in an accessible manner, emphasize current and future relevance to them and their illness, involve trusted clinicians in recruitment and minimize the burden of trial participation. Participation in clinical trials was seen as an opportunity for people to give back to the health system and for future people in their predicament.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Talia Gutman
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrea K Viecelli
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Kidney Health Australia, Victoria, Melbourne, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeremy R Chapman
- Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - David W Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lisa Murphy
- Kidney Health Australia, Victoria, Melbourne, Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | | | - Emily Duncanson
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Shyamsundar Muthuramalingam
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Amber Williamson
- BEAT-CKD Consumer Advisory Board, Sydney, New South Wales, Australia.,Kidney Health Australia, Queensland Consumer Consultative Committee, Brisbane, Queensland, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, SA Health and Medical Research Institute, Adelaide, South Australia, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia.,Westmead Clinical School, Westmead Institute for Medical Research, New South Wales, Westmead, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Giovanni F M Strippoli
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.,Cochrane Kidney and Transplant, Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, New South Wales, Sydney, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, New South Wales, Westmead, Australia
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7
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Harrison TG, Skrtic M, Verdin NE, Lanktree MB, Elliott MJ. Improving Sexual Function in People With Chronic Kidney Disease: A Narrative Review of an Unmet Need in Nephrology Research. Can J Kidney Health Dis 2020; 7:2054358120952202. [PMID: 32953127 PMCID: PMC7485155 DOI: 10.1177/2054358120952202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose of review: Sexual dysfunction occurs commonly in people with chronic kidney
disease (CKD) and has been recognized as a research priority. We
sought to evaluate the current state of the literature
addressing sexual dysfunction in people with CKD and identify
barriers and strategies to improve our management of this
important symptom. Sources of information: OVID Medline and Google Scholar were searched for English,
peer-reviewed studies using keywords and terms related to
“Chronic Kidney Disease,” “sexuality,” and “sexual dysfunction
OR function.” Methods: In this narrative review, we describe definitions of sexual
dysfunction and contributors exacerbated by CKD, barriers to
researching sexual dysfunction in people with CKD, and possible
avenues for future research. Key findings: Sexual dysfunction is common in people with CKD and results from a
combination of kidney disease itself, as well as its associated
physical (ie, comorbidities) and nonphysical factors. Barriers
to the study of sexual dysfunction in CKD include inconsistent
disease definitions, stigma, variable efficacy and safety of
established therapies, and evolving gender roles in sexual
function. Potential avenues for future research to improve the
sexual function in people with CKD may include evaluating the
safety and efficacy of established therapies in people with CKD
using a variety of observational and interventional study
designs, engaging people with CKD and multidisciplinary team
members in research, and using implementation science methods to
translate what is known about sexual function into clinical
practice. Concerted efforts are required to break down barriers
and improve sexual function in people with CKD. Patients have
identified this as an important research priority, and national
networks need to direct efforts to reduce symptom burden. Limitations: This narrative review was limited by a paucity of high-quality
studies examining sexual dysfunction specifically in people with
kidney disease.
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Affiliation(s)
- Tyrone G Harrison
- Section of Nephrology, Department of Medicine, University of Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, AB, Canada
| | - Marko Skrtic
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, ON, Canada.,Department of Cell Biology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Nancy E Verdin
- Patient and Community Engagement Research Unit, O'Brien Institute for Public Health, University of Calgary, AB, Canada
| | - Matthew B Lanktree
- Division of Nephrology, Department of Medicine, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
| | - Meghan J Elliott
- Section of Nephrology, Department of Medicine, University of Calgary, AB, Canada.,Department of Community Health Sciences, University of Calgary, AB, Canada
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8
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Duncanson E, Dansie K, Gutman T, Tong A, Howell M, Jesudason S, Reidlinger D, Williamson A, Scholes‐Robertson N, Murphy L, Hawley CM, Craig JC, Johnson DW, McDonald S. ‘Knowledge is power’: A framework for partnering with consumers in developing and delivering a scientific meeting in nephrology. Nephrology (Carlton) 2020; 25:379-383. [DOI: 10.1111/nep.13570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Emily Duncanson
- Australia and New Zealand Dialysis and Transplant RegistrySouth Australian Health and Medical Research Institute Adelaide South Australia Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant RegistrySouth Australian Health and Medical Research Institute Adelaide South Australia Australia
| | - Talia Gutman
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
- Centre for Kidney ResearchThe Children's Hospital at Westmead Sydney New South Wales Australia
| | - Allison Tong
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
- Centre for Kidney ResearchThe Children's Hospital at Westmead Sydney New South Wales Australia
| | - Martin Howell
- Sydney School of Public HealthThe University of Sydney Sydney New South Wales Australia
| | - Shilpanjali Jesudason
- Central and Northern Adelaide Renal and Transplantation Service and Royal Adelaide Hospital Adelaide South Australia Australia
- Kidney Health Australia Adelaide South Australia Australia
- Faculty of Health and Medical SciencesUniversity of Adelaide Adelaide South Australia Australia
| | - Donna Reidlinger
- Australasian Kidney Trials Network Brisbane Queensland Australia
- University of Queensland Brisbane Queensland Australia
| | - Amber Williamson
- BEAT‐CKD Consumer Advisory Board Australia
- Kidney Health AustraliaQueensland Consumer Consultative Committee Brisbane Queensland Australia
| | - Nicole Scholes‐Robertson
- Centre for Kidney ResearchThe Children's Hospital at Westmead Sydney New South Wales Australia
- BEAT‐CKD Consumer Advisory Board Australia
| | - Lisa Murphy
- Kidney Health Australia Adelaide South Australia Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network Brisbane Queensland Australia
- Department of NephrologyPrincess Alexandra Hospital Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | - Jonathan C Craig
- College of Medicine and Public HealthFlinders University South Australia Australia
| | - David W Johnson
- Australasian Kidney Trials Network Brisbane Queensland Australia
- Department of NephrologyPrincess Alexandra Hospital Brisbane Queensland Australia
- Translational Research Institute Brisbane Queensland Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant RegistrySouth Australian Health and Medical Research Institute Adelaide South Australia Australia
- Central and Northern Adelaide Renal and Transplantation Service and Royal Adelaide Hospital Adelaide South Australia Australia
- Faculty of Health and Medical SciencesUniversity of Adelaide Adelaide South Australia Australia
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Heenan M. An opportunity for improved engagement and transparency: A systematic review of renal dialysis cost effectiveness and discrete choice experiment studies. Healthc Manage Forum 2020; 33:200-205. [PMID: 32281409 DOI: 10.1177/0840470420916775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Much attention is given to patient and provider engagement, cost, and quality. Nephrology is in a unique position to examine the intersection of these issues given kidney dialysis is delivered at a high cost to chronically ill patients. Annual dialysis treatments in Canada range from $56,000-$107,000 per patient dependent on modality. Economists quantify the preferred modality by calculating cost effectiveness through quality-adjusted life years or determining utilization through Discrete Choice Experiments (DCEs). Cost-effectiveness studies identify peritoneal dialysis as the most economical, yet it is the least used. Discrete choice experiments address patient preferences but rarely include cost attributes. This presents a unique paradigm: cost studies do not include patient or physician perspectives, and DCEs do not consider cost. This systematic review of dialysis cost-effectiveness studies and DCEs identifies an opportunity to increase engagement and transparency by involving all care partners in assessing quality and cost.
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Epidemiology research to foster improvement in chronic kidney disease care. Kidney Int 2020; 97:477-486. [DOI: 10.1016/j.kint.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/12/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022]
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Silver SA, Gerarduzzi C. Found in Translation: Reasons for Optimism in the Pursuit to Prevent Chronic Kidney Disease After Acute Kidney Injury. Can J Kidney Health Dis 2019; 6:2054358119868740. [PMID: 31452903 PMCID: PMC6698989 DOI: 10.1177/2054358119868740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/21/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose of review: The current review will discuss on the progress of studying the transition
phase between acute kidney injury (AKI) and chronic kidney disease (CKD)
through improved animal models, common AKI and CKD pathways, and how human
studies may inform different translational approaches. Sources of information: PubMed and Google Scholar. Methods: A narrative review was performed using the main terms “acute kidney injury,”
“chronic kidney disease,” “end-stage renal disease,” “animal models,”
“review,” “decision-making,” and “translational research.” Key findings: The last decade has shown much progress in the study of AKI, including
evidence of a pathophysiological link between AKI and CKD. We are now in a
phase of redesigning animal models and discovering mechanisms that can
replicate the pathological conditions of the AKI-to-CKD continuum.
Translating these findings into the clinic is a barrier that must be
overcome. To this end, current efforts include prediction of AKI onset and
maladaptive repair, detecting patients susceptible to the progression of
chronic maladaptive repair, and understanding shared signaling mechanisms
between AKI and CKD. Limitations: This is a narrative review of the literature that is partially influenced by
the knowledge, perspectives, and experiences of the authors and their
research background. Implications: Overall, this new knowledge from the AKI-to-CKD continuum will help bridge
the discontinuity that exists between animal models and patients, resulting
in more effective translational biomarkers and therapeutics to test in known
AKI pathologies thereby preventing the chronicity of kidney injury
progression.
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Affiliation(s)
- Samuel A. Silver
- Division of Nephrology, Kingston Health
Sciences Center, Queen’s University, Kingston, ON, Canada
| | - Casimiro Gerarduzzi
- Division de Néphrologie, Centre de
recherche de l’Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Département de Médecine, Faculté de
Médecine, Université de Montréal, Montréal, Québec, Canada
- Casimiro Gerarduzzi, Division de
Néphrologie, Centre de recherche de l’Hôpital Maisonneuve-Rosemont, 5345,
boulevard de l’Assomption, Montreal, QC H1T 2M4, Canada.
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Cassidy BP, Getchell LE, Harwood L, Hemmett J, Moist LM. Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review. Can J Kidney Health Dis 2018; 5:2054358118803322. [PMID: 30542621 PMCID: PMC6236635 DOI: 10.1177/2054358118803322] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE OF REVIEW Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients. SOURCES OF INFORMATION PubMed and Google Scholar. METHODS A narrative review was performed using the main terms "chronic kidney disease," "CKD," "dialysis," "review," "decision-making," "decision aids," "education," and "barriers." Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed. KEY FINDINGS Eight common themes were identified as influencers for decision making. "Patient-focused" themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and "clinician-focused" themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines. LIMITATIONS This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable. IMPLICATIONS Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.
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Affiliation(s)
- Brendan P. Cassidy
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Leah E. Getchell
- Kidney, Dialysis and Transplantation
Program, ICES Western, London, ON, Canada
| | - Lori Harwood
- Renal Services, London Health Sciences
Centre, London, ON, Canada
| | - Juliya Hemmett
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Louise M. Moist
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
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