Perspectives of Patients, Nurses, and Nephrologists About Electronic Symptom Monitoring With Feedback in Hemodialysis Care

Andrea K Viecelli; Emily Duncanson; Paul N Bennett; Matilda D'Antoine; Kathryn Dansie; William Handke; Allison Tong; Suetonia Palmer; Shilpanjali Jesudason; Stephen McDonald; Rachael L Morton; Symptom Monitoring With Feedback Trial (SWIFT) Investigators

doi:10.1053/j.ajkd.2021.12.007

Perspectives of Patients, Nurses, and Nephrologists About Electronic Symptom Monitoring With Feedback in Hemodialysis Care

Am J Kidney Dis. 2022 Aug;80(2):215-226.e1. doi: 10.1053/j.ajkd.2021.12.007. Epub 2022 Jan 25.

Collaborators

Symptom Monitoring With Feedback Trial (SWIFT) Investigators:
Matthew Jose, Chris Brown, Liliana Laranjo, Fergus Caskey, Cecile Couchoud, David Johnson, David Harris, Rachael Walker, Enrico Coiera, Carmel Hawley, R John Simes

Affiliations

¹ Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia.
² Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia.
³ Clinical & Health Sciences, University of South Australia, Adelaide, Australia; Medical and Clinical Affairs, Satellite Healthcare, San Jose, California.
⁴ Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
⁵ Informal caregiver, Canberra, Australia.
⁶ Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia.
⁷ Department of Medicine, University of Otago, Christchurch, New Zealand.
⁸ Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
⁹ Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.
¹⁰ NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia. Electronic address: [email protected].

PMID: 35085687
DOI: 10.1053/j.ajkd.2021.12.007

Abstract

Rationale & objective: Patients receiving hemodialysis experience high symptom burden and low quality of life (QOL). Electronic patient-reported outcome measures (e-PROMs) monitoring with feedback to clinicians may be an acceptable intervention to improve health-related QOL for patients receiving hemodialysis. This study explored patient and clinician perspectives on e-PROMs monitoring with feedback to clinicians.

Study design: Qualitative study.

Setting & participants: 41 participants (12 patients, 13 nephrologists, 16 dialysis nurses) who participated in a 6-month feasibility pilot study of adults receiving facility-based hemodialysis across 4 Australian units. The intervention consisted of electronic symptom monitoring with feedback to clinicians, who also received evidence-based symptom management recommendations to improve health-related QOL.

Analytical approach: Semistructured interviews and focus group discussions explored the feasibility and acceptability of e-PROMs monitoring with feedback to clinicians. We conducted a thematic analysis of transcripts.

Results: We identified 4 themes: enabling efficient, systematic, and multidisciplinary patient-centered care; experiencing limited data and options for symptom management; requiring familiarity with technology and processes; and identifying barriers and competing priorities. While insufficient patient engagement, logistic/technical challenges, and delayed symptom feedback emerged as barriers to implementation, active engagement by nurses in encouraging and supporting patients during survey completion and clinicians' prompt action after symptom feedback were considered to be facilitators to implementation.

Limitations: Limited generalizability due to inclusion of English-speaking participants only.

Conclusions: Patients, nurses, and nephrologists considered e-PROMs monitoring with feedback to clinicians feasible for symptom management in hemodialysis. Clinician engagement, patient support, reliable technology, timely symptom feedback, and interventions to address symptom burden are likely to improve its implementation within research and clinical settings.

Keywords: Electronic PROMs; electronic survey; end-stage renal disease (ESRD); feasibility; focus group; hemodialysis; interviews; patient-centered health care; patient-reported outcome measures (PROMs); qualitative research; quality of life (QOL); symptom assessment; symptom management; technology acceptance.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Australia
Electronics
Feedback
Humans
Nephrologists*
Pilot Projects
Quality of Life*
Renal Dialysis