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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