Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
BMJ Open. 2021 Aug 26;11(8):e052629. doi: 10.1136/bmjopen-2021-052629.
Patients undergoing haemodialysis report elevated symptoms and reduced health-related quality of life, and often prioritise improvements in psychosocial well-being over long-term survival. Systematic collection and use of patient-reported outcomes (PROs) may help support tailored healthcare and improve outcomes. This study investigates the methodological basis for routine PRO assessment, particularly using electronic formats (ePROs), to maximise the potential of PRO use, through exploration of the experiences, views and perceptions of patients and healthcare professionals (HCPs) on implementation and use of PROs in haemodialysis settings.
Qualitative study.
Semistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK.
Transcripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis.
For effective implementation, the potential value of PROs needs to be demonstrated empirically to stakeholders. Any intervention must remain flexible enough for individual and aggregate use, measuring outcomes that matter to patients and clinicians, while maintaining operational simplicity. Any implementation must sit within a wider framework of education and support for both patients and clinicians who demonstrate varying previous experience of using PROs and often confuse related concepts. Implementation plans must recognise the multidimensionality of end-stage kidney disease and treatment by haemodialysis, while acknowledging the associated challenges of delivering care in a highly specialised environment. To support implementation, careful consideration needs to be given to barriers and facilitators including effective leadership, the role of champions, effective launch and ongoing evaluation.
Using the CFIR to explore the experiences, views and perceptions of key stakeholders, this study identified key factors at organisational and individual levels which could assist effective implementation of ePROs in haemodialysis settings. Further research will be required to evaluate subsequent ePRO interventions to demonstrate the impact and benefit to the dialysis community.
接受血液透析的患者报告称症状加重，生活质量相关方面下降，他们往往更重视改善心理社会健康状况，而不是长期生存。系统地收集和使用患者报告的结局（PRO）可能有助于支持个性化医疗保健并改善结局。本研究通过调查患者和医疗保健专业人员（HCP）对在血液透析环境中实施和使用 PRO 的经验、观点和看法，探索常规 PRO 评估的方法基础，特别是使用电子格式（ePRO），以最大限度地发挥 PRO 的潜力。
定性研究。
在英国，对 22 名接受血液透析的患者和 17 名 HCP 进行了半结构化访谈。
使用整合实施研究框架（CFIR）对转录本进行演绎分析，并使用主题分析进行归纳分析。
为了有效实施，需要向利益相关者证明 PRO 的潜在价值。任何干预措施都必须保持足够的灵活性，以便个人和总体使用，衡量对患者和临床医生重要的结果，同时保持操作简单。任何实施都必须置于为患者和临床医生提供教育和支持的更广泛框架内，他们表现出使用 PRO 的不同以往经验，并且经常混淆相关概念。实施计划必须认识到终末期肾病和血液透析治疗的多维性，同时承认在高度专业化的环境中提供护理的相关挑战。为了支持实施，需要仔细考虑包括有效领导、拥护者的角色、有效启动和持续评估在内的障碍和促进因素。
使用 CFIR 来探讨关键利益相关者的经验、观点和看法，本研究确定了组织和个人层面上的关键因素，这些因素可能有助于在血液透析环境中有效实施电子 PRO。需要进一步研究以评估随后的 ePRO 干预措施，以证明对透析社区的影响和益处。
