Satisfaction with Care of Patients on Hemodialysis

Identifying Patient Satisfaction Determinants in Hemodialysis Settings: A Systematic Review

Purpose

Patient satisfaction is a measure of care quality that assists providers in determining the effectiveness of their services while meeting patients’ expectations. This study aimed to review existing studies that have focused on patients’ satisfaction determinants in Hemodialysis (HD) settings.

Methods

Electronic databases (PubMed, ScienceDirect, Scopus, and Google Scholar) were searched from 2000 onwards to identify studies using search terms related to patient satisfaction and hemodialysis centers. Article review was limited to studies written in English. A total of 19 articles were included by following the PRISMA statement. Data were extracted using a structured form and summarized in a tabular format to identify different determinants that showed a relationship with patient satisfaction. Determinants were classified into provider-related determinants and patient-related characteristics.

Results

Provider-related determinants of patient satisfaction in HD centers include staff, facility, service, and treatment. Patient-related characteristics associated with satisfaction include demographics and health status history. Based on this systematic review, key correlates of patient satisfaction in hemodialysis centers include: staff, facility, service, treatment, patient’s demographics, and health status.

Conclusion

The findings of this study can help healthcare facilities in taking measures in line with the specified determinants to enhance patient satisfaction and improve the organizational performance of the healthcare centers. It is important to constantly study and improve these determinants based on patient feedback to improve patient satisfaction and quality of care.

Count Me Out: Perceptions of Black Patients Who are on Dialysis but Who are Not on a Transplant Waitlist

End-stage renal disease (ESRD) is characterized by racial inequity; Blacks are 3 times more likely to develop ESRD than Whites. Transplant is the preferred treatment option since transplanted patients experience better clinical outcomes. Racial inequities persist at each of the steps required for transplantation. Despite the vast literature describing these racial inequities, it does not include dialysis patients' awareness and understanding of treatment options, specifically for transplant. To address this gap, we purposely sampled Blacks in Detroit who were receiving dialysis and who were not active on any transplant waitlist to investigate their understanding and perceptions of transplants. We used uncertainty management theory (UMT) to better understand perceived barriers to getting and remaining on a transplant waitlist. We aimed to address a critical gap in the literature to inform approaches addressing this enduring inequity. For this qualitative study, we conducted individual, semi-structured interviews with 24 Black ESRD patients, aged 34-73 years: 9 male and 15 female. Participants shared their experiences of being on dialysis, perceptions, and understanding of transplants. We describe two key findings: 1) uncertainty for these patients is prevalent and multi-layered and 2) social support can both dissuade an individual from pursuing transplant (i.e., reluctance to ask family members to be donors) and it can result in decreasing uncertainty (e.g., participants wanting to pursue transplant to be with family). We highlight the specific need to improve patient education regarding treatment options and enhancing how relevant health information can be communicated.

Hemodialysis and Peritoneal Dialysis Patients’ Problems: Patients’ Perspective

Background: End-stage renal disease (ESRD) can be fatal without hemodialysis, peritoneal dialysis, or kidney transplantation. Hemodialysis and peritoneal dialysis participants confront many adverse effects due to both the disease course and the treatment program. Objectives: This study was done to analyze hemodialysis and peritoneal dialysis patients’ problems. Methods: A qualitative exploratory study was used, and a purposeful sample of 55 hemodialysis and 47 peritoneal dialysis patients were interviewed. The data were collected through interviews. Initially, 12 open-ended questions were developed and used to stimulate discussions in interview sessions. Directed content analysis was used for the analysis of the transcribed data. After giving a code to each line or incidence, codes were then compared for similarity and differences, merged, and categorized. Results: Themes of fatigue, diminished ability, sleeplessness, wasting time, body impairments, travel, and free-time activities limitations, low blood pressure, displeasure and gratification with hemodialysis if peritoneal dialysis patients compliant of peritoneal catheter problems, peritoneal dialysis difficulties and limitations, and gratification with peritoneal dialysis emerged. Conclusions: Hemodialysis problems and patients' dependency on the hemodialysis machine and ward are at a high level, and patients’ gratification is at a low level. Peritoneal dialysis patients, who do not get the infection, are satisfied with the dialysis method, and the patients' limitations and problems are fewer, and they are relaxed and have more freedom.

Contributions of treatment centre and patient characteristics to patient-reported experience of haemodialysis: a national cross-sectional study

OBJECTIVES

To examine the relative importance of patient and centre level factors in determining self-reported experience of care in patients with advanced kidney disease treated by maintenance haemodialysis (HD).

DESIGN

Analysis of data from a cross sectional national survey; the UK Renal Registry (UKRR) national Kidney patient-reported experience measure (PREM) survey (2018). Centre-level data were obtained from the UKRR report (2018).

SETTING

National survey of patients with advanced kidney disease receiving treatment with maintenance HD in UK renal centres in 2018.

PARTICIPANTS

The Kidney PREM was distributed to all UK renal centres by the UKRR in May 2018. Each centre invited patients receiving outpatient treatment for kidney disease to complete the PREM. These included patients with chronic kidney disease, those receiving dialysis-both HD and peritoneal dialysis, and those with a functioning kidney transplant. There were no formal inclusion/exclusion criteria.

MAIN OUTCOME MEASURES

The Kidney PREM has 38 questions in 13 subscales. Responses were captured using a 7-point Likert scale (never 1, always 7). The primary outcome of interest was the mean PREM score calculated across all questions. Multilevel modelling was used to determine the proportion of variation of the mean PREM score across centres due to patient-related and centre-related factors.

RESULTS

There were records for 8253 HD patients (61% men, 77% white) from 69 renal centres (9-710 patients per centre). There was significant variation in mean PREM score across centres (5.35-6.53). In the multivariable analysis there was some variation in relation to both patient- and centre-level factors but these contributed little to explaining the overall variation. However, multilevel modelling showed that the overwhelming proportion of the explained variance (45%) was explained by variation between centres (40%), only a small proportion of which is identified by measured factors. Only 5% of the variation was related to patient-level factors.

CONCLUSIONS

Centre rather than patient characteristics determine the experience of care of patients receiving HD. Further work is required to define the characteristics of the treating centre which determine patient experience.

Development and Content Validity of a Patient-Reported Experience Measure for Home Dialysis

BACKGROUND AND OBJECTIVES

The population of patients with kidney failure in the United States using home dialysis modalities is growing rapidly. Unlike for in-center hemodialysis, there is no patient-reported experience measure for assessment of patient experience of care for peritoneal dialysis or home hemodialysis. We sought to develop and establish content validity of a patient-reported experience measure for patients undergoing home dialysis using a mixed methods multiple stakeholder approach.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We conducted a structured literature review, followed by concept elicitation focus groups and interviews among 65 participants, including 21 patients on home dialysis, 33 home dialysis nurses, three patient care partners, and eight nephrologists. We generated a list of candidate items for possible measure inclusion and conducted a national prioritization exercise among 91 patients on home dialysis and 39 providers using a web-based platform. We drafted the Home Dialysis Care Experience instrument and conducted cognitive debriefing interviews to evaluate item interpretability, order, and structure. We iteratively refined the measure on the basis of interview findings.

RESULTS

The literature review and concept elicitation phases supported 15 domains of home dialysis care experience in six areas: communication and education of patients, concern and helpfulness of the care team, proficiency of the care team, patient-centered care, care coordination, and amenities and environment. Focus groups results showed that domains of highest importance for measure inclusion were patient education and communication, care coordination, and personalization of care. Prioritization exercise results confirmed focus group findings. Cognitive debriefing indicated that the final measure was easily understood and supported content validity.

CONCLUSIONS

The Home Dialysis Care Experience instrument is a 26-item patient-reported experience measure for use in peritoneal dialysis and home hemodialysis. The Home Dialysis Care Experience instrument represents the first rigorously developed and content-valid English-language instrument for assessment of patient-reported experience of care in home dialysis.

Hemodialysis as long term treatment: Patients satisfaction and its impact on quality of life

Objective:

To determine the level of satisfaction as hemodialysis a long term treatment and quality of life in patients off End Stage Kidney Disease ESKD on hemodialysis.

Methods:

A cross-sectional study was carried out from January to April 2019 in hemodialysis unit of Lahore General Hospital on 141 ESKD patients by using self-designed questionnaire after informed consent.

Results:

Majority (82.56%) of the participants were satisfied with the care provided at the dialysis center. except with the time spent with doctor and 36.9% were not satisfied with their cannulation technique for dialysis. About 89.9% were satisfied with the knowledge provided to them about self-care. Satisfaction is subjective well-being in different aspects of life, including mental health and behavior of people experiencing serious health concerns. Quality of Life (QOL) is defined as “perception of one’s position in life, in the light of his culture and customs, consisting someone’s goals, standards or expectations. Financial problems to the patient was limited to the transportation as dialysis session and erythropoietin were free, but 54.1% of the patients were unable to earn due to their disease even those who were working ,80% of them had to take the day off for dialysis. The financial burden and debilitating illness didn’t cause separation/divorce from spouse but led to increased frequency of scuffles. Among the unmarried population, 40% of it does not want to start a relationship and 40% is facing difficulties in finding a partners while 97.9% of the population is satisfied with the psychological and emotional support of family.

Conclusion:

Most patients were satisfied with their decision of opting hemodialysis as treatment and care provided at dialysis centre, although Quality of Life was badly affected in terms of financial and psycho-social aspects. Employed, married with good income have good quality of life. Loopholes of unit environment and health education were also exposed. Despite the medical advancement and emerging techniques to make dialysis better, the outcome of hemodialysis has yet to reach a safe level and more work should be done to improve patient’s outcome.

Hemodialysis patient characteristics associated with better experience as measured by the In-center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey

BACKGROUND

Patient experience in hemodialysis (HD) is measured twice yearly in all in-center HD patients in the United States using the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH CAHPS) survey. Survey scores are publically available and incorporated into the dialysis payment system. Despite its importance, little is known about factors associated with better experience scores. We studied the association between patient-level characteristics and experience scores in a large real-world cohort of HD patients.

METHODS

This is a cross-sectional analysis of ICH CAHPS administration in 2012. All in-center HD patients in Dialysis Clinic, Incorporated facilities nationally over 18 years old and receiving HD at their facility for at least 3 months were eligible. Predictors include patient demographic, clinical, and treatment-related characteristics. Outcomes include high global rating scores across three domains (Nephrologist, Dialysis Staff, Dialysis Center) and high composite scores across three domains (Nephrologists' Communication and Caring, Quality of Dialysis Center Care and Operations, and Providing Information to Patients).

RESULTS

Among 3369 respondents, older age and telephone (vs. mail) administration of the survey were associated with higher global ratings, while shortened HD treatments were associated with lower global ratings. Lower education and telephone administration were associated with higher composite scores, while older age, and shortened HD treatments were associated with lower composite scores.

CONCLUSIONS

Several patient characteristics and mode of survey administration are associated with higher experience scores. Future research should assess HD facility characteristics associated with higher scores and interventions that might improve experience accounting for these associations.

Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey

Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care.