1
|
Flythe JE, Forfang D, Gedney N, White DM, Wilkie C, Cavanaugh KL, Harris RC, Unruh M, Squillaci G, West M, Mansfield C, Soloe CS, Treiman K, Wood D, Hurst FP, Neuland CY, Saha A, Sheldon M, Tarver ME. Development of a Patient Preference Survey for Wearable Kidney Replacement Therapy Devices. Kidney360 2022; 3:1197-1209. [PMID: 35919522 PMCID: PMC9337889 DOI: 10.34067/kid.0001862022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 01/11/2023]
Abstract
Background Recent innovations have the potential to disrupt the current paradigm for kidney failure treatment. The US Food and Drug Administration is committed to incorporating valid scientific evidence about how patients weigh the benefits and risks of new devices into their decision making, but to date, premarket submission of patient preference information (PPI) has been limited for kidney devices. With input from stakeholders, we developed a survey intended to yield valid PPI, capturing how patients trade off the potential benefits and risks of wearable dialysis devices and in-center hemodialysis. Methods We conducted concept elicitation interviews with individuals receiving dialysis to inform instrument content. After instrument drafting, we conducted two rounds of pretest interviews to evaluate survey face validity, comprehensibility, and perceived relevance. We pilot tested the survey with in-center hemodialysis patients to assess comprehensibility and usability further. Throughout, we used participant input to guide survey refinements. Results Thirty-six individuals receiving in-center or home dialysis participated in concept elicitation (N=20) and pretest (N=16) interviews. Participants identified reduced fatigue, lower treatment burden, and enhanced freedom as important benefits of a wearable device, and many expressed concerns about risks related to device disconnection-specifically bleeding and infection. We drafted a survey that included descriptions of the risks of serious bleeding and serious infection and an assessment of respondent willingness to wait for a safer device. Input from pretest interviewees led to various instrument modifications, including treatment descriptions, item wording, and risk-level explanations. Pilot testing of the updated survey among 24 in-center hemodialysis patients demonstrated acceptable survey comprehensibility and usability, although 50% of patients required some assistance. Conclusions The final survey is a 54-item web-based instrument that will yield estimates of the maximal acceptable risk for the described wearable device and willingness to wait for wearable devices with lower risk.
Collapse
Affiliation(s)
- Jennifer E. Flythe
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina,Cecil G. Sheps Center for Health Services Research, UNC, Chapel Hill, North Carolina
| | - Derek Forfang
- Kidney Health Initiative Patient and Family Partnership Council, San Pablo, California
| | | | - David M. White
- Kidney Health Initiative Patient and Family Partnership Council, Hillcrest Heights, Maryland
| | - Caroline Wilkie
- Kidney Health Initiative Patient and Family Partnership Council, Punta Gorda, Florida
| | - Kerri L. Cavanaugh
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee,Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Raymond C. Harris
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mark Unruh
- School of Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Grace Squillaci
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Melissa West
- Kidney Health Initiative and American Society of Nephrology, Washington, DC
| | - Carol Mansfield
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Cindy S. Soloe
- RTI Health Solutions, Research Triangle Park, North Carolina
| | | | - Dallas Wood
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Frank P. Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Carolyn Y. Neuland
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Anindita Saha
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Murray Sheldon
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Michelle E. Tarver
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| |
Collapse
|
2
|
Pérez-Morales R, Buades-Fuster JM, Esteve-Simó V, Macía-Heras M, Mora-Fernández C, Navarro-González JF. Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis. J Clin Med 2022; 11:jcm11030861. [PMID: 35160312 PMCID: PMC8836773 DOI: 10.3390/jcm11030861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022] Open
Abstract
The success of hemodialysis (HD) treatments has been evaluated using objective measures of analytical parameters, or machine-measured parameters, despite having available validated instruments that assess patient perspective. There is an emerging interest regarding the use and relevance of patient-related outcomes (PROs). Electronic PROs (ePROs) involve the use of electronic technology, provide rapid access to this information, and are becoming more widely used in clinical trials and studies to evaluate efficacy and safety. Despite the scarce literature, this review suggests that ePROs are useful in providing a more customized and multidimensional approach to patient management and in making better clinical decisions in relevant aspects such as vascular access, duration and frequency of dialysis sessions, treatment of anemia, mental health, fatigue, and quality of life. The purpose of this review is to raise interest in the systematic use of ePROs in HD and to promote the development of studies in this field, which can respond to the gaps in knowledge and contribute to the implementation of the use of ePROs through new technologies, helping to improve the quality of health care.
Collapse
Affiliation(s)
- Rosa Pérez-Morales
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
- Correspondence:
| | - Juan Manuel Buades-Fuster
- Nephrology Service, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07148 Palma, Spain;
- Fundació Institut d’Investigació Sanitària Illes Balears, Carretera de Valldemossa, 79, Hospital Universitario Son Espases, Edificio S, 07120 Palma de Mallorca, Spain
| | - Vicent Esteve-Simó
- Nephrology Service, Consorci Sanitari de Terrassa, Carretera Torrebonica, s/n, 08227 Terrassa, Spain;
| | - Manuel Macía-Heras
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
| | - Carmen Mora-Fernández
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Juan F. Navarro-González
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain; (M.M.-H.); (J.F.N.-G.)
- Research Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
- RICORS2040 (RD21/0005/0013), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Instituto de Tecnologías Biomédicas, Facultad de Ciencias de la Salud, Sección de Medicina, Universidad de La Laguna, 38200 Santa Cruz de Tenerife, Spain
| |
Collapse
|