Gabbard Jennifer, McLouth Christopher J, Brenes Gretchen, Claudel Sophie, Ongchuan Samantha, Burkart John, Pajewski Nicholas, Callahan Kathryn E, Williamson Jeff D, Murea Mariana
Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.
Center for Health Care Innovation, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.
Am J Hosp Palliat Care. 2021 May;38(5):432-440. doi: 10.1177/1049909120954805. Epub 2020 Sep 16.
Patients with end-stage renal disease (ESRD) have a high burden of physical and psychological symptoms. Many remain unrecognized for long periods of time, particularly in older adults. The best strategy to monitor patient-reported outcome measures (PROMs) has not been identified.
To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD).
We designed an iPad application-delivery system for collecting electronic PROMs (ePROMs). Patient's ≥60 years of age with ESRD on HD were recruited from a single outpatient dialysis unit. Feasibility was evaluated based on recruitment, retention, and the system usability score (SUS). Assessments were completed at baseline, 3 months, and 6 months after enrollment. ANOVA was used to assess longitudinal symptom variability.
Twenty-two patients (49% recruitment rate) were enrolled, with an 82% retention at 6 months. Mean age was 69.4 years (SD 6.6), 63.6% were female, and 81.8% were African American. Participants reported minimal difficulty in using the app, with an overall SUS score of 77.6. There were no significant relationships between demographic characteristics (age, race, or education) and SUS. Baseline SF-12 physical score and SF-12 mental score were 40.4 (SD 9.1) and 33.9 (SD 6.7), respectively. No significant changes were seen in longitudinal ePROMs of pain, depression, or anxiety; but was seen in the dialysis symptom index.
In older patients with ESRD, collection of iPad-based ePROMs is feasible. This process can overcome inefficiencies associated with paper questionnaires and enable systematic monitoring of symptom burden.
终末期肾病（ESRD）患者承受着沉重的身心症状负担。许多症状长期未被识别，尤其是在老年人中。尚未确定监测患者报告结局指标（PROMs）的最佳策略。
评估在接受血液透析（HD）的老年ESRD患者中实施基于iPad的症状评估工具的可行性。
我们设计了一个用于收集电子患者报告结局指标（ePROMs）的iPad应用程序交付系统。从一个门诊透析单元招募年龄≥60岁的HD-ESRD患者。基于招募、留存率和系统可用性评分（SUS）评估可行性。在入组后基线、3个月和6个月完成评估。采用方差分析评估纵向症状变异性。
招募了22名患者（招募率49%），6个月时留存率为82%。平均年龄为69.4岁（标准差6.6），63.6%为女性，81.8%为非裔美国人。参与者报告使用该应用程序的困难最小，总体SUS评分为77.6。人口统计学特征（年龄、种族或教育程度）与SUS之间无显著关系。基线SF-12身体评分和SF-12心理评分分别为40.4（标准差9.1）和33.9（标准差6.7）。疼痛、抑郁或焦虑的纵向ePROMs无显著变化；但在透析症状指数中可见变化。
在老年ESRD患者中，收集基于iPad的ePROMs是可行的。这一过程可以克服与纸质问卷相关的低效问题，并能够系统地监测症状负担。
