Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave, Edmonton, Alberta, T6G 1C9, Canada.
Faculty of Medicine and Dentistry, Division of Nephrology, University of Alberta, 11-112 Clinical Science Building, 11350-83 Ave, Edmonton, AB, T6G 2G3, Canada.
Syst Rev. 2019 Jan 12;8(1):20. doi: 10.1186/s13643-018-0911-6.
Patient-reported outcomes and experience measures (jointly referred to here as PROs) are internationally recognized as a means for patients to provide information about their quality of life, symptoms, and experiences with care. Although increasingly recognized as key to improving the quality of healthcare at individual (e.g., patients, caregivers, and providers) and aggregate (e.g., government, policy/system-wide decision-making) levels, there are important knowledge gaps in our understanding of how PROs are, and can be, used across different settings, particularly in nephrology to enhance person-centered care. This knowledge is needed for developing strategies to guide optimal use of PROs in nephrology care. Currently, no strategies exist. The purpose of this review is to address this knowledge gap by answering the following realist question: How can PROs be used to enhance person-centered nephrology care, both at individual and aggregate levels?
Realist synthesis is an explanatory approach to data synthesis that aims to explain how context and mechanisms influence the outcome of an intervention. An initial program theory will be developed through the systematic search of the published literature in bibliographic databases (Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL, Web of Science, and Scopus) on existing theories explaining how PROs are used in healthcare settings. This initial program theory will then be tested and refined through the process of realist synthesis, using context-mechanism-outcome configurations. A kidney-specific program theory will then be created to address the utilization of PROs in nephrology across individual and aggregate levels to augment person-centered care. Searching will be iterative and refined as data is extracted and analyzed using a pilot-tested context + mechanism = outcome heuristic. Throughout, we will consult methodological experts, research team practitioners, and the Patient Advisory Committee to help refine the theories. Last, we will develop and disseminate knowledge translation products widely to knowledge user groups.
The utilization of PROs remains a challenge in nephrology. The findings from this synthesis will provide a framework to guide both policy makers and practitioners on how to enhance person-centered care through successful utilization of PROs across individual and aggregate levels in nephrology.
PROSPERO CRD42017056063.
患者报告的结局和体验测量（以下简称 PROs）被国际公认为患者提供生活质量、症状和医疗体验信息的一种手段。尽管越来越多的人认识到 PROs 是改善个体（如患者、护理人员和提供者）和总体水平（如政府、政策/系统范围的决策制定）医疗质量的关键，但我们对 PROs 在不同环境中的使用方式及其局限性的理解仍存在重要的知识差距，特别是在肾脏病学领域，以增强以患者为中心的护理。这对于制定指导肾脏病护理中 PROs 最佳使用策略的相关知识是必要的。目前，尚无此类策略。本综述旨在通过回答以下实际问题来填补这一知识空白：如何在个体和总体水平上使用 PROs 来增强以患者为中心的肾脏病护理？
真实主义综合是一种数据综合的解释方法，旨在解释背景和机制如何影响干预的结果。通过在文献数据库（Ovid MEDLINE、Ovid Embase、EBSCOhost CINAHL、Web of Science 和 Scopus）中系统地搜索现有理论，以解释 PROs 在医疗保健环境中的使用方式，来制定初始计划理论。然后，将通过真实主义综合过程，使用上下文-机制-结果配置来测试和完善初始计划理论。然后，将创建一个针对肾脏的特定计划理论，以解决在个体和总体水平上利用 PROs 来增强以患者为中心的护理的问题。随着使用经过试点测试的上下文+机制=结果启发式方法提取和分析数据，搜索将是迭代和完善的。在整个过程中，我们将咨询方法学专家、研究团队从业者和患者咨询委员会，以帮助完善理论。最后，我们将广泛开发和传播知识转化产品，以满足知识用户群体的需求。
在肾脏病学中，PROs 的使用仍然是一个挑战。这项综合研究的结果将为政策制定者和从业者提供一个框架，指导他们如何通过在肾脏病学中成功地在个体和总体水平上利用 PROs 来增强以患者为中心的护理。
PROSPERO CRD42017056063。
