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Gill JK, Pucci M, Samudio A, Ahmed T, Siddiqui R, Edwards N, Marticorena RM, Donnelly S, Lok C, Wentlandt K, Wolofsky K, Mucsi I. Self-reported MeasUrement of Physical and PsychosOcial Symptoms Response Tool (SUPPORT-dialysis): systematic symptom assessment and management in patients on in-centre haemodialysis - a parallel arm, non-randomised feasibility pilot study protocol. BMJ Open 2024; 14:e080712. [PMID: 38296283 PMCID: PMC10828879 DOI: 10.1136/bmjopen-2023-080712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Patients with kidney failure experience symptoms that are often under-recognised and undermanaged. These symptoms negatively impact health-related quality of life and are associated with adverse clinical outcomes. Regular symptom assessment, using electronic patient reported outcomes measure (ePROMs) linked to systematic symptom management, could improve such outcomes. Clinical implementation of ePROMs have been successful in routine oncology care, but not used for patients on dialysis. In this study, we describe a pilot study of ePROM-based systematic symptom monitoring and management intervention in patients treated with in-centre haemodialysis. METHODS AND ANALYSIS This is a parallel-arm, controlled pilot of adult patients receiving in-centre maintenance haemodialysis. Participants in the intervention arm will complete ePROMs once a month for 6 months. ePROMs will be scored real time and the results will be shared with participants and with the clinical team. Moderate-severe symptoms will be flagged using established cut-off scores. Referral options for those symptoms will be shared with the clinical team, and additional symptom management resources will also be provided for both participants and clinicians. Participants in the control arm will be recruited at a different dialysis unit, to prevent contamination. They will receive usual care, except that they will complete ePROMs without the presentation of results to participants of the clinical team. The primary objectives of the pilot are to assess (1) the feasibility of a larger, randomised clinical effectiveness trial and (2) the acceptability of the intervention. Interviews conducted with participants and staff will be assessed using a content analysis approach. ETHICS AND DISSEMINATION Ethical approval for this study was obtained from the University Health Network (REB#21-5199) and the William Osler Health System (#23-0005). All study procedures will be conducted in accordance with the standards of University Health Network research ethics board and with the 1964 Helsinki declaration and its later amendments. Results of this study will be shared with participants, patients on dialysis and other stakeholders using lay language summaries, oral presentations to patients and nephrology professionals. We will also be publishing the results in a peer-reviewed journal and at scientific meetings. PROTOCOL VERSION 4 (16 November 2022). TRIAL REGISTRATION NUMBER NCT05515991.
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Affiliation(s)
- Jasleen Kaur Gill
- Institute of Medical Science, University of Toronto-St George Campus, Toronto, Ontario, Canada
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Maria Pucci
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Ana Samudio
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | - Tibyan Ahmed
- Multi-organ Transplant, UHN, Toronto, Ontario, Canada
| | | | | | - Rosa M Marticorena
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Sandra Donnelly
- Nephrology Program, Sir William Osler Health System, Brampton, Ontario, Canada
| | - Charmaine Lok
- Division of Nephrology, UHN, Toronto, Ontario, Canada
| | | | - Kayla Wolofsky
- Department of Supportive Care, UHN, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Medicine, Multiorgan Transplant Program, University of Toronto, Toronto, Ontario, Canada
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Consolo L, Basile I, Colombo S, Rusconi D, Pasquot L, Campa T, Caraceni A, Lusignani M. Exploring patient perspectives on electronic patient-reported outcome measures in home-based cancer palliative care: A qualitative study. Digit Health 2024; 10:20552076241249962. [PMID: 38665884 PMCID: PMC11044777 DOI: 10.1177/20552076241249962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background Electronic patient-reported outcomes (ePROMs) enhance symptom management and patients' engagement in palliative cancer care. However, integrating them into this setting brings challenges, including patients' familiarity with technological devices and declining health status. Prioritizing the patient's acceptability and feasibility is crucial for their adoption. However, more knowledge is needed about patients' perspectives on the adoption of ePROMs in the community, especially for home-based palliative care. Aim Explore patient viewpoints on utilizing ePROMs for symptom reporting in home-based oncology palliative care. Design A qualitative interpretative approach was used to evaluate patients' points of view on using ePROMs in this specific care setting. Semistructured interviews were carried out. Data were analyzed using a reflexive thematic analysis. Setting/participants A total of 25 patients receiving oncological home palliative care from the advanced palliative care unit of the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, were invited to participate. Twenty interviews were conducted, as five patients declined due to deteriorating health. Results Four themes were identified: (1) strategic value of ePROMs and subjective appreciation; (2) enhancing patient centeredness through ePROMs; (3) exploring and addressing concerns about the use of ePROMs and (4) intersecting factors influencing the efficacy of ePROMs. Conclusion Despite initial reticence, home palliative care patients consider ePROMs as potentially valuable allies monitoring symptoms, enhancing their quality of life, and amplifying their voices on less explored aspects of care. Continuous dialog between healthcare professionals and patients is crucial for addressing patient skepticism about ePROMs and their impact on the human aspect of care.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
- Bachelor School of Nursing, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Basile
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stella Colombo
- Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Daniele Rusconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Loredana Pasquot
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Anderson NE, Kyte D, McMullan C, Cockwell P, Aiyegbusi OL, Verdi R, Calvert M. Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study. BMJ Open 2023; 13:e070927. [PMID: 37438075 DOI: 10.1136/bmjopen-2022-070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation. STUDY DESIGN ePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses. SETTING AND PARTICIPANTS Eligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system. ANALYTICAL APPROACH Structured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research. RESULTS Fifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application. CONCLUSIONS There has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now.
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Affiliation(s)
- Nicola Elizabeth Anderson
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Christel McMullan
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Partner, Institute of Applied Health Research,Centre for Patient-Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
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Vedadi A, Khairalla R, Che A, Nagee A, Saqib M, Ayub A, Wasim A, Macanovic S, Orchanian-Cheff A, Selzner-Malekkiani N, Bartlett S, Mucsi I. Patient-reported outcomes and patient-reported outcome measures in liver transplantation: a scoping review. Qual Life Res 2023:10.1007/s11136-023-03405-1. [PMID: 37022585 DOI: 10.1007/s11136-023-03405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Generic or condition-specific Patient-reported Outcome Measures (PROMs) are used to measure physical, mental, and social aspects of health to promote patient-centered care. This scoping review aims to identify and summarize generic and condition-specific PRO domains and PROMs that have been assessed and used in liver transplant (LT) candidates and recipients. METHODS We searched Medline, Embase, Cochrane Database of Systematic Reviews and Register of Trials, PsychInfo, and CINAHL from inception to 08/26/2020. Included studies addressed a PRO or PROM in LT candidates or recipients. RESULTS After screening, 341 studies yielded 189 unique PRO domains. Mental health domains (depression, anxiety, and guilt) were most frequently assessed, followed by domains of physical and social health. Fifty-one generic and three condition-specific unique PROMs were identified, with only 13% (n = 45) of studies including condition-specific tools. DISCUSSION The most frequent PROMs were the SF-36, Nottingham Health Profile, Hospital Anxiety and Depression Scale, followed by the Liver Disease Quality of Life (LDQoL). Very few studies used transplant-specific PROMs, which may partly be related to the scarcity of LT-specific instruments. We will use these results in future qualitative research to identify PROs and PROMs to build an electronic PROM toolkit to facilitate patient-centered LT care.
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Affiliation(s)
- Ali Vedadi
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Roula Khairalla
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Adrian Che
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ahsas Nagee
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Mohammed Saqib
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ali Ayub
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aghna Wasim
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sara Macanovic
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Nazia Selzner-Malekkiani
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Susan Bartlett
- Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Centre, Montreal, QC, Canada
| | - Istvan Mucsi
- Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada.
- Multi-Organ Transplant Unit, Toronto General Hospital, University Health Network, PMB 11C-188, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
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Nagendrababu V, Vinothkumar TS, Rossi-Fedele G, Doğramacı EJ, Duncan HF, Abbott PV, Levin L, Lin S, Dummer PMH. Dental patient-reported outcomes following traumatic dental injuries and treatment: A narrative review. Dent Traumatol 2023. [PMID: 36744323 DOI: 10.1111/edt.12827] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 02/07/2023]
Abstract
Dental patient-reported outcomes (dPROs) are self-reported descriptions of a patient's oral health status that are not modified or interpreted by a healthcare professional. Dental patient-reported outcome measures (dPROMs) are objective or subjective measurements used to assess dPROs. In oral healthcare settings, the emphasis on assessing treatment outcomes from the patient's perspective has increased and this is particularly important after traumatic dental injuries (TDIs), as this group of injuries represent the fifth most prevalent disease or condition worldwide. The purpose of this review is to summarize the current use of dPROs and dPROMs in the field of dental traumatology. Oral Health-Related Quality of Life, pain, swelling, aesthetics, function, adverse effects, patient satisfaction, number of clinical visits and trauma-related dental anxiety are the key dPROs following TDIs. Clinicians and researchers should consider the well-being of patients as their top priority and conduct routine evaluations of dPROs using measures that are appropriate, accurate and reflect what is important to the patient. After a TDI, dPROs can assist clinicians and patients to choose the best management option(s) for each individual patient and potentially improve the methodology, design and relevance of clinical studies.
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Affiliation(s)
| | - Thilla Sekar Vinothkumar
- Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan, Saudi Arabia.,Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | | | - Esma J Doğramacı
- Adelaide Dental School, University of Adelaide, Adelaide, South Australia, Australia
| | - Henry F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - Paul V Abbott
- UWA Dental School, The University of Western Australia, Perth, Western Australia, Australia
| | - Liran Levin
- Faculty of Medicine and Dentistry, University of Alberta, Alberta, Edmonton, Canada
| | - Shaul Lin
- The Israeli National Center for Trauma & Emergency Medicine Research, Gertner Institute, Tel Hashomer, Israel.,Department of Endodontics, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Viecelli AK, Duncanson E, Bennett PN, D'Antoine M, Dansie K, Handke W, Tong A, Palmer S, Jesudason S, McDonald S, Morton RL. Perspectives of Patients, Nurses, and Nephrologists About Electronic Symptom Monitoring With Feedback in Hemodialysis Care. Am J Kidney Dis 2022; 80:215-226.e1. [PMID: 35085687 DOI: 10.1053/j.ajkd.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 01/27/2023]
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.
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Affiliation(s)
- Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Emily Duncanson
- 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
| | - Paul N Bennett
- Clinical & Health Sciences, University of South Australia, Adelaide, Australia; Medical and Clinical Affairs, Satellite Healthcare, San Jose, California
| | - Matilda D'Antoine
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kathryn Dansie
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Allison Tong
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Shilpanjali Jesudason
- Central Northern Adelaide Renal and Transplantation Service, Adelaide, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Stephen McDonald
- 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
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, Australia.
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Kyte D, Anderson N, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson LJ, O'Brien S, Price G, Sharpe K, Stringer S, Verdi R, Waters J, Wilcockson A. Results of a pilot feasibility randomised controlled trial exploring the use of an electronic patient-reported outcome measure in the management of UK patients with advanced chronic kidney disease. BMJ Open 2022; 12:e050610. [PMID: 35304391 PMCID: PMC8935185 DOI: 10.1136/bmjopen-2021-050610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The use of routine remote follow-up of patients with chronic kidney disease (CKD) is increasing exponentially. It has been suggested that online electronic patient-reported outcome measures (ePROMs) could be used in parallel, to facilitate real-time symptom monitoring aimed at improving outcomes. We tested the feasibility of this approach in a pilot trial of ePROM symptom monitoring versus usual care in patients with advanced CKD not on dialysis. DESIGN A 12-month, parallel, pilot randomised controlled trial (RCT) and qualitative substudy. SETTING AND PARTICIPANTS Queen Elizabeth Hospital Birmingham, UK. Adult patients with advanced CKD (estimated glomerular filtration rate ≥6 and ≤15 mL/min/1.73 m2, or a projected risk of progression to kidney failure within 2 years ≥20%). INTERVENTION Monthly online ePROM symptom reporting, including automated feedback of tailored self-management advice and triggered clinical notifications in the advent of severe symptoms. Real-time ePROM data were made available to the clinical team via the electronic medical record. OUTCOMES Feasibility (recruitment and retention rates, and acceptability/adherence to the ePROM intervention). Health-related quality of life, clinical data (eg, measures of kidney function, kidney failure, hospitalisation, death) and healthcare utilisation. RESULTS 52 patients were randomised (31% of approached). Case report form returns were high (99.5%), as was retention (96%). Overall, 73% of expected ePROM questionnaires were received. Intervention adherence was high beyond 90 days (74%) and 180 days (65%); but dropped beyond 270 days (46%). Qualitative interviews supported proof of concept and intervention acceptability, but highlighted necessary changes aimed at enhancing overall functionality/scalability of the ePROM system. LIMITATIONS Small sample size. CONCLUSIONS This pilot trial demonstrates that patients are willing to be randomised to a trial assessing ePROM symptom monitoring. The intervention was considered acceptable; though measures to improve longer-term engagement are needed. A full-scale RCT is considered feasible. TRIAL REGISTRATION NUMBER ISRCTN12669006 and the UK NIHR Portfolio (CPMS ID: 36497).
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Affiliation(s)
- Derek Kyte
- School of Applied Health & Community, University of Worcester, Worcester, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Nicola Anderson
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonia O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
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Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
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9
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Anderson NE, McMullan C, Calvert M, Dutton M, Cockwell P, Aiyegbusi OL, Kyte D. Using patient-reported outcome measures during the management of patients with end-stage kidney disease requiring treatment with haemodialysis (PROM-HD): a qualitative study. BMJ Open 2021; 11:e052629. [PMID: 34446501 PMCID: PMC8395280 DOI: 10.1136/bmjopen-2021-052629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES 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. STUDY DESIGN Qualitative study. SETTING AND PARTICIPANTS Semistructured interviews with 22 patients undergoing haemodialysis, and 17 HCPs in the UK. ANALYTICAL APPROACH Transcripts were analysed deductively using the Consolidated Framework for Implementation Research (CFIR) and inductively using thematic analysis. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nicola Elzabeth Anderson
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR SMRC, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Mary Dutton
- Research and Development, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
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10
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Calvert M, King M, Mercieca-Bebber R, Aiyegbusi O, Kyte D, Slade A, Chan AW, Basch E, Bell J, Bennett A, Bhatnagar V, Blazeby J, Bottomley A, Brown J, Brundage M, Campbell L, Cappelleri JC, Draper H, Dueck AC, Ells C, Frank L, Golub RM, Griebsch I, Haywood K, Hunn A, King-Kallimanis B, Martin L, Mitchell S, Morel T, Nelson L, Norquist J, O'Connor D, Palmer M, Patrick D, Price G, Regnault A, Retzer A, Revicki D, Scott J, Stephens R, Turner G, Valakas A, Velikova G, von Hildebrand M, Walker A, Wenzel L. SPIRIT-PRO Extension explanation and elaboration: guidelines for inclusion of patient-reported outcomes in protocols of clinical trials. BMJ Open 2021; 11:e045105. [PMID: 34193486 PMCID: PMC8246371 DOI: 10.1136/bmjopen-2020-045105] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/21/2020] [Accepted: 01/08/2021] [Indexed: 01/21/2023] Open
Abstract
Patient-reported outcomes (PROs) are used in clinical trials to provide valuable evidence on the impact of disease and treatment on patients' symptoms, function and quality of life. High-quality PRO data from trials can inform shared decision-making, regulatory and economic analyses and health policy. Recent evidence suggests the PRO content of past trial protocols was often incomplete or unclear, leading to research waste. To address this issue, international, consensus-based, PRO-specific guidelines were developed: the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT)-PRO Extension. The SPIRIT-PRO Extension is a 16-item checklist which aims to improve the content and quality of aspects of clinical trial protocols relating to PRO data collection to minimise research waste, and ultimately better inform patient-centred care. This SPIRIT-PRO explanation and elaboration (E&E) paper provides information to promote understanding and facilitate uptake of the recommended checklist items, including a comprehensive protocol template. For each SPIRIT-PRO item, we provide a detailed description, one or more examples from existing trial protocols and supporting empirical evidence of the item's importance. We recommend this paper and protocol template be used alongside the SPIRIT 2013 and SPIRIT-PRO Extension paper to optimise the transparent development and review of trial protocols with PROs.
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Affiliation(s)
- Melanie Calvert
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
- NIHR Applied Research Collaboration West Midlands, University of Birmingham, Birmingham, UK
| | - Madeleine King
- Faculty of Science, School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca Mercieca-Bebber
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Olalekan Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Biomedical Research Centre, Institute of Translational Medicine, Birmingham, UK
| | - Derek Kyte
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Slade
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - An-Wen Chan
- Women's College Research Institute, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - E Basch
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jill Bell
- Oncology Digital Health, AstraZeneca, Gaithersburg, Maryland, USA
| | - Antonia Bennett
- Cancer Outcomes Research Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Jane Blazeby
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Andrew Bottomley
- Department of Quality of Life, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Michael Brundage
- Department of Oncology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada
| | - Lisa Campbell
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Joseph C Cappelleri
- Global Biometrics & Data Management-Statistics, Pfizer Inc, New York City, New York, USA
| | | | - Amylou C Dueck
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Carolyn Ells
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Lori Frank
- Patient-Centered Outcomes Research Institute, Washington, DC, USA
| | | | | | - Kirstie Haywood
- Warwick Research in Nursing, University of Warwick, Warwick Medical School, Coventry, UK
| | | | | | | | | | - Thomas Morel
- Patient-Centered Outcomes Research, UCB Pharma, Brussels, Belgium
| | - Linda Nelson
- Value Evidence and Outcomes-Patient Centered Outcomes, GSK, Collegeville, Pennsylvania, USA
| | - Josephine Norquist
- Center for Observational Real-world Evidence (CORE), Patient-Centered Endpoints & Strategy, Merck & Co Inc, Kenilworth, New Jersey, USA
| | - Daniel O'Connor
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Michael Palmer
- Cancer Research Institute, Queen's University, Kingston, Ontario, Canada
| | - Donald Patrick
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Gary Price
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Ameeta Retzer
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jane Scott
- Johnson and Johnson, Janssen Global Services LLC, High Wycombe, UK
| | | | - Grace Turner
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, Birmingham, UK
| | - Antonia Valakas
- EMD Serono Inc, Healthcare Business of Merck KGaA, Darmstadt, Germany
| | - Galina Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maria von Hildebrand
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Lari Wenzel
- University of California, Irvine, California, USA
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11
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Schick-Makaroff K, Levay A, Thompson S, Flynn R, Sawatzky R, Thummapol O, Klarenbach S, Karimi-Dehkordi M, Greenhalgh J. An Evidence-Based Theory About PRO Use in Kidney Care: A Realist Synthesis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:21-38. [PMID: 34109571 DOI: 10.1007/s40271-021-00530-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is international interest on the use of patient-reported outcomes (PROs) in nephrology. OBJECTIVES Our objectives were to develop a kidney-specific program theory about use of PROs in nephrology that may enhance person-centered care, both at individual and aggregated levels of care, and to test and refine this theory through a systematic review of the empirical literature. Together, these objectives articulate what works or does not work, for whom, and why. METHODS Realist synthesis methodology guided the electronic database and gray literature searches (in January 2017 and October 2018), screening, and extraction conducted independently by three reviewers. Sources included all nephrology patients and/or practitioners. Through a process of extraction and synthesis, each included source was examined to assess how contexts may trigger mechanisms to influence specific outcomes. RESULTS After screening 19,961 references, 84 theoretical and 34 empirical sources were used. PROs are proposed to be useful for providing nephrology care through three types of use. The first type is use of individual-level PRO data at point of care, receiving the majority of theoretical and empirical explorations. Clinician use to support person-centered care, and patient use to support patient engagement, are purported to improve satisfaction, health, and quality of life. Contextual factors specific to the kidney care setting that may influence the use of PRO data include the complexity of kidney disease symptom burden, symptoms that may be stigmatized, comorbidities, and time or administrative constraints in dialysis settings. Electronic collection of PROs may facilitate PRO use given these contexts. The second type is use of aggregated PRO data at point of care, including public reporting of PROs to inform decisions at point of care and improve quality of care, and use of PROs for treatment decisions. The third type is use of aggregated PRO data by organizations, including publicly available PRO data to compare centers. In single-payer systems, regular collection of PROs by dialysis centers can be achieved through economic incentives. Both the second and third types of PRO use include pressures that may trigger quality improvement processes. CONCLUSION The current state of the evidence is primarily theoretical. There is pressing need for empirical research to improve the evidence-base of PRO use at individual and aggregated levels of nephrology care.
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Affiliation(s)
- Kara Schick-Makaroff
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada.
| | - Adrienne Levay
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Stephanie Thompson
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Third Floor, Edmonton Clinica Health Academy, Edmonton, AB, Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, BC, Canada.,Centre for Health Evaluation & Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Onouma Thummapol
- Faculty of Nursing Science, Assumption University of Thailand, Bangkok, Thailand
| | - Scott Klarenbach
- Division of Nephrology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mehri Karimi-Dehkordi
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
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12
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van der Veer SN, Couchoud C, Morton RL. The role of kidney registries in expediting large-scale collection of patient-reported outcome measures for people with chronic kidney disease. Clin Kidney J 2021; 14:1495-1503. [PMID: 34276974 PMCID: PMC8280932 DOI: 10.1093/ckj/sfab061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Indexed: 11/21/2022] Open
Abstract
In this issue of Clinical Kidney Journal, Van der Willik et al. report findings from a pilot study where they introduced collection of patient-reported outcome measures (PROMs) into routine kidney care in Dutch dialysis centres. It is comparable to a registry-led PROMs initiative in Sweden, published in Clinical Kidney Journal in 2020. Both studies reported low average PROMs response rates with substantial between-centre variation, and both identified suboptimal patient and staff engagement as a key barrier to implementing PROMs in routine care for people with chronic kidney disease (CKD). This suggests that national kidney registries could be well placed to facilitate large-scale collection of PROMs data, but that they may require additional guidance on how to do this successfully. In this editorial, we discuss the current state-of-play of PROMs collection by kidney registries and provide an overview of what is (un)known about the feasibility and effectiveness of PROMs in CKD and other conditions. We anticipate that the fast-growing evidence base on whether, and how, PROMs can be of value in CKD settings will expedite registry-based PROMs collection, which will ultimately lead to more valuable and person-centred services and to enhanced health and well-being of people with CKD.
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Affiliation(s)
- Sabine N van der Veer
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Cecile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint Denis La Plaine, France
| | - Rachael L Morton
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, Australia
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13
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Gabbard J, McLouth CJ, Brenes G, Claudel S, Ongchuan S, Burkart J, Pajewski N, Callahan KE, Williamson JD, Murea M. Rapid Electronic Capturing of Patient-Reported Outcome Measures in Older Adults With End-Stage Renal Disease: A Feasibility Study. Am J Hosp Palliat Care 2020; 38:432-440. [PMID: 32935548 DOI: 10.1177/1049909120954805] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND 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. OBJECTIVE To assess the feasibility of implementing an iPad-based symptom assessment tool in older adults with ESRD on hemodialysis (HD). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Jennifer Gabbard
- 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
| | - Christopher J McLouth
- Department of Behavioral Science, 12252University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Gretchen Brenes
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sophie Claudel
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha Ongchuan
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John Burkart
- Section on Nephrology, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nicholas Pajewski
- Center for Health Care Innovation, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Biostatistics and Data Science, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Callahan
- 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
| | - Jeff D Williamson
- 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
| | - Mariana Murea
- Section on Nephrology, Department of Internal Medicine, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
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14
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Kyte D, Anderson N, Auti R, Aiyegbusi OL, Bishop J, Bissell A, Brettell E, Calvert M, Chadburn M, Cockwell P, Dutton M, Eddington H, Forster E, Hadley G, Ives NJ, Jackson L, O'Brien S, Price G, Sharpe K, Stringer S, Stephenson G, Verdi R, Waters J, Wilcockson A, Williams J. Development of an electronic patient-reported outcome measure (ePROM) system to aid the management of patients with advanced chronic kidney disease. J Patient Rep Outcomes 2020; 4:55. [PMID: 32642867 PMCID: PMC7343684 DOI: 10.1186/s41687-020-00223-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/28/2020] [Indexed: 11/22/2022] Open
Abstract
Background Effective management of patients with chronic kidney disease (CKD) relies on timely detection of clinical deterioration towards end stage kidney failure. We aimed to design an electronic Patient-Reported Outcome Measure (ePROM) system, which would allow patients with advanced CKD (pre-dialysis) to: (i) remotely self-report their symptoms using a simple and secure online platform; (ii) share the data with the clinical team in real-time via the electronic patient record to help optimise care. We adopted a staged development process which included: a systematic review of PROMs used in CKD; formation of a co-design team; prototype system design/development, user acceptance testing and refinement; finalisation of the system for testing in a pilot/feasibility trial. Results A co-design team was convened, including patients with lived experience of CKD; clinical team members; IT/Informatics experts; academics; and Birmingham Clinical Trials Unit representatives. A prototype system was developed and iterative changes made before finalisation during a series of operational meetings. The system allows patients to remotely self-report their symptoms; provides tailored self-management advice; allows monitoring of real-time patient ePROM data; sends automated notifications to the patient/clinical team in the advent of a severe symptom report; and incorporates longitudinal ePROM symptom data into the electronic patient record. Feasibility of the system will be evaluated as part of the National Institute for Health Research funded RePROM (Renal electronic Patient-Reported Outcome Measure) pilot trial (ISRCTN12669006). Conclusions Routine ePROM collection with real-time feedback has the potential to improve outcomes and reduce health service costs. We have successfully developed a trial-ready ePROM system for advanced CKD, the feasibility of which is currently being explored in a pilot trial. Assuming feasibility is demonstrated, formal evaluation of efficacy will take place in a future multi-centre randomised controlled trial.
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Affiliation(s)
- Derek Kyte
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK. .,Institute of Applied Health Research, University of Birmingham, Birmingham, UK. .,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.
| | - Nicola Anderson
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ram Auti
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK
| | - Jon Bishop
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Andrew Bissell
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Brettell
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,National Institute for Health Research Birmingham Biomedical Research Centre, The Murray Learning Centre, University of Birmingham, Birmingham, UK.,National Institute for Health Research Applied Research Centre West Midlands, University of Birmingham, Birmingham, UK.,National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, Birmingham, UK.,Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Marie Chadburn
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mary Dutton
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Eddington
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Elliot Forster
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gabby Hadley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie J Ives
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sonja O'Brien
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gary Price
- Centre for Patient-Reported Outcomes Research, University of Birmingham, Birmingham, UK.,Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Keeley Sharpe
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Gael Stephenson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Rav Verdi
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Judi Waters
- Patient Advisory Group, Centre for Patient-Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adrian Wilcockson
- Birmingham Clinical Trials Unit (BCTU), Institute of Applied Health Research University of Birmingham, Birmingham, UK
| | - Jim Williams
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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15
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Aiyegbusi OL. Key methodological considerations for usability testing of electronic patient-reported outcome (ePRO) systems. Qual Life Res 2019; 29:325-333. [PMID: 31691202 PMCID: PMC6994506 DOI: 10.1007/s11136-019-02329-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 11/29/2022]
Abstract
Introduction Recent advances in information technology and improved access to the internet have led to a rapid increase in the adoption and ownership of electronic devices such as touch screen smartphones and tablet computers. This has also led to a renewed interest in the field of digital health also referred to as telehealth or electronic health (eHealth). There is now a drive to collect these PROs electronically using ePRO systems.
Method However, the user interfaces of ePRO systems need to be adequately assessed to ensure they are not only fit for purpose but also acceptable to patients who are the end users. Usability testing is a technique that involves the testing of systems, products or websites with participants drawn from the target population. Usability testing can assist ePRO developers in the evaluation of ePRO user interface. The complexity of ePRO systems; stage of development; metrics to measure; and the use of scenarios, moderators and appropriate sample sizes are key methodological issues to consider when planning usability tests. Conclusion The findings from usability testing may facilitate the improvement of ePRO systems making them more usable and acceptable to end users. This may in turn improve the adoption of ePRO systems post-implementation. This article highlights the key methodological issues to consider and address when planning usability testing of ePRO systems.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcome Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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16
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Aiyegbusi OL, Kyte D, Cockwell P, Marshall T, Dutton M, Walmsley-Allen N, Slade A, McMullan C, Calvert M. Patient and Clinician Perspectives on Electronic Patient-Reported Outcome Measures in the Management of Advanced CKD: A Qualitative Study. Am J Kidney Dis 2019; 74:167-178. [PMID: 31003865 DOI: 10.1053/j.ajkd.2019.02.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE Chronic kidney disease (CKD) can substantially affect patients' health-related quality of life. Electronic patient-reported outcome measures (ePROMs) may capture symptoms and health-related quality of life and assist in the management of CKD. This study explored patient and clinician views on the use of a renal ePROM system. STUDY DESIGN Qualitative study. SETTING & PARTICIPANTS 12 patients with stage 4 or 5 CKD (non-dialysis dependent); 22 clinicians (6 CKD community nurses, 1 clinical psychologist, 10 nephrologists, 3 specialist registrars, and 2 renal surgeons) in the United Kingdom. ANALYTICAL APPROACH Semi-structured interviews and focus group discussion during which patients received paper versions of the Kidney Disease Quality of Life-36 and the Integrated Patient Outcome Scale-Renal to exemplify the type of content that could be included in an ePROM. Thematic analysis of interview transcripts. RESULTS 4 themes were identified: (1) general opinions of PROMs, (2) potential benefits and applications of an ePROM system, (3) practical considerations for the implementation of ePROMs, and (4) concerns, barriers, and facilitators. Patients were willing to complete ePROMs on a regular basis as part of their care despite clinician concerns about patient burden. Patients assessed the questionnaires favorably. Clinicians suggested that the extent of adoption of renal ePROM systems in routine clinical settings should be based on evidence of significant impact on patient outcomes. Clinicians were concerned that an ePROM system may raise patient expectations to unrealistic levels and expose clinicians to the risk for litigation. Patients and clinicians identified potential benefits and highlighted issues and concerns that need to be addressed to ensure the successful implementation of the renal ePROM system. LIMITATIONS Transferability of the findings may be limited because only English-speaking participants were recruited to the study. CONCLUSIONS A renal ePROM system may play a supportive role in the routine clinical management of patients with advanced CKD if the concerns of clinicians and patients can be sufficiently addressed.
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Affiliation(s)
- Olalekan Lee Aiyegbusi
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
| | - Derek Kyte
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University Hospitals, Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom
| | - Paul Cockwell
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Tom Marshall
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Mary Dutton
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Natalie Walmsley-Allen
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Anita Slade
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Christel McMullan
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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