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Goodrich J, Watson C, Gaczkowska I, Harding R, Evans C, Firth A, Murtagh FE. Understanding patient and family utilisation of community-based palliative care services out-of-hours: Additional analysis of systematic review evidence using narrative synthesis. PLoS One 2024; 19:e0296405. [PMID: 38381768 PMCID: PMC10880966 DOI: 10.1371/journal.pone.0296405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/12/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Community-based out-of-hours services are an integral component of end-of-life care. However, there is little understanding of how patients and families utilise these services. This additional analysis of a systematic review aims to understand and identify patterns of out-of-hours service use and produce recommendations for future service design. METHOD Data on service use was extracted and secondary analysis undertaken, from a systematic review of models of community out-of-hours services. Narrative synthesis was completed, addressing four specific aspects of service use: 1.Times when patients/families/healthcare professionals need to contact out-of-hours services; 2. Who contacts out-of-hours services; 3. Whether a telephone call, centre visit or home visit is provided; 4. Who responds to out-of-hours calls. RESULTS Community-based out-of-hours palliative care services were most often accessed between 5pm and midnight, especially on weekdays (with reports of 69% of all calls being made out-of-hours). Family members and carers were the most frequent callers to of the services (making between 60% and 80% of all calls). The type of contact (telephone, centre visit or home visit) varied based on what was offered and on patient need. Over half of services were led by a single discipline (nurse). CONCLUSIONS Out-of-hours services are highly used up to midnight, and particularly by patients' family and carers. Recommendations to commissioners and service providers are to: • Increase provision of out-of-hours services between 5pm and midnight to reflect the increased use at these times. • Ensure that family and carers are provided with clear contact details for out-of-hours support. • Ensure patient records can be easily accessed by health professionals responding to calls, making the triage process easier. • Listen to patients, family and carers in the design of out-of-hours services, including telephone services. • Collect data systematically on out-of-hours-service use and on outcomes for patients who use the service.
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Affiliation(s)
- Joanna Goodrich
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Caleb Watson
- King’s College London Medical School, London, United Kingdom
| | - Inez Gaczkowska
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Richard Harding
- King’s College London Medical School, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
- Sussex Community NHS Foundation Trust, Brighton, United Kingdom
| | - Alice Firth
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King’s College London, London, United Kingdom
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Chambers RL, Pask S, Higginson IJ, Barclay S, Murtagh FE, Sleeman KE. Inclusion of palliative and end of life care in health strategies aimed at integrated care: a documentary analysis. healthopenres 2023; 4:19. [PMID: 36987529 PMCID: PMC7614372 DOI: 10.12688/amrcopenres.13079.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: In England, Integrated Care Systems have been established to improve integration of care, as part of the NHS Long Term Plan. For people near the end of life, palliative care can improve integration of care. We aimed to understand whether and how palliative and end of life care was included in Integrated Care System strategies, and to consider priorities for strengthening this. Methods: Documentary analysis of Integrated Care System (ICS) strategies, using summative content analysis, was performed. Google searches were used to identify NHS Trust, Clinical Commissioning Group or ICS websites. We searched these websites to identify strategies. Key terms were used to identify relevant content. Themes were mapped onto an adapted logic model for integrated care. Results: 23 Integrated Care System strategy documents were identified. Of these, two did not mention any of the key terms, and six highlighted palliative and end of life care as either a priority, area of focus, or an ambition. While most (19/23) strategies included elements that could be mapped onto the adapted logic model for integrated care, the thread from enablers and components, to structures, processes, outcomes, and impact was incomplete. Conclusions: Greater prioritisation of palliative and end of life care within recently established Integrated Care Systems could improve outcomes for people near the end of life, as well as reduce reliance on acute hospital care. Integrated Care Systems should consider involving patients, the public and palliative care stakeholders in the ongoing development of strategies. For strategies to be effective, our adapted logic model can be used to outline how different components of care fit together to achieve defined outcomes and impact.
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Affiliation(s)
- Rachel L. Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fliss E.M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
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3
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Neo SHS, Tan JYT, Sim DKL, Ng ESL, Loh JKX, Yang GM, Murtagh FE, Cheung YB. Validity and Reliability of the Integrated Palliative Care Outcome Scale in Asian Heart Failure Patients. Palliat Med Rep 2022; 3:287-295. [DOI: 10.1089/pmr.2022.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shirlyn Hui-Shan Neo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Jasmine Yun-Ting Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Elaine Swee-Ling Ng
- Nursing Specialty Care Unit, National Heart Centre Singapore, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Yin Bun Cheung
- Program in Health Services & Systems Research and Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Centre for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
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4
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Van Biesen W, Jha V, Abu-Alfa AK, Andreoli SP, Ashuntantang G, Bernieh B, Brown E, Chen Y, Coppo R, Couchoud C, Cullis B, Douthat W, Eke FU, Hemmelgarn B, Hou FF, Levin NW, Luyckx VA, Morton RL, Moosa MR, Murtagh FE, Richards M, Rondeau E, Schneditz D, Shah KD, Tesar V, Yeates K, Garcia Garcia G. Considerations on equity in management of end-stage kidney disease in low- and middle-income countries. Kidney Int Suppl (2011) 2020; 10:e63-e71. [PMID: 32149010 PMCID: PMC7031686 DOI: 10.1016/j.kisu.2019.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/11/2019] [Accepted: 11/07/2019] [Indexed: 12/17/2022] Open
Abstract
Achievement of equity in health requires development of a health system in which everyone has a fair opportunity to attain their full health potential. The current, large country-level variation in the reported incidence and prevalence of treated end-stage kidney disease indicates the existence of system-level inequities. Equitable implementation of kidney replacement therapy (KRT) programs must address issues of availability, affordability, and acceptability. The major structural factors that impact equity in KRT in different countries are the organization of health systems, overall health care spending, funding and delivery models, and nature of KRT prioritization (transplantation, hemodialysis or peritoneal dialysis, and conservative care). Implementation of KRT programs has the potential to exacerbate inequity unless equity is deliberately addressed. In this review, we summarize discussions on equitable provision of KRT in low- and middle-income countries and suggest areas for future research.
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Affiliation(s)
- Wim Van Biesen
- Nephrology Department, Ghent University Hospital, Ghent, Belgium
| | - Vivekanand Jha
- George Institute for Global Health India, New Delhi, India
- Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Ali K. Abu-Alfa
- Division of Nephrology and Hypertension, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Sharon P. Andreoli
- Department of Pediatrics, Pediatric Nephrology, Indiana University Medical Center, Indianapolis, Indiana, USA
| | - Gloria Ashuntantang
- Faculty of Medicine and Biomedical Sciences, Yaounde General Hospital, University of Yaounde, Yaounde I, Cameroon
| | - Bassam Bernieh
- Home Hemodialysis for Home Dialysis, Al Ain, United Arab Emirates
- The Heart Medical Center, Al Ain, United Arab Emirates
| | - Edwina Brown
- Imperial College Healthcare National Health Service Trust, London, UK
| | - Yuqing Chen
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, Turin, Italy
| | - Cecile Couchoud
- French Renal Epidemiology and Information Network (REIN) Registry, Biomedicine Agency, Paris, France
| | - Brett Cullis
- Renal Unit, Greys Hospital, Pietermaritzburg, South Africa
| | - Walter Douthat
- Hospital Privado-Universitario de Cordoba and Instituto Universitario de Ciencias Biomédicas, Cordoba, Argentina
| | - Felicia U. Eke
- Department of Pediatrics, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Brenda Hemmelgarn
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Fan Fan Hou
- State Key Laboratory of Organ Failure Research, National Clinical Research Center for Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Nathan W. Levin
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Valerie A. Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Mohammed Rafique Moosa
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Fliss E.M. Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Eric Rondeau
- Intensive Care Nephrology and Transplantation Department, Hopital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Graz, Austria
| | | | - Vladimir Tesar
- Department of Nephrology, General University Hospital, Charles University, Prague, Czech Republic
| | - Karen Yeates
- Division of Nephrology, Queen’s University, Kingston, Ontario, Canada
| | - Guillermo Garcia Garcia
- Servicio de Nefrologia, Hospital Civil de Guadalajara Fray Antonio Alcalde, University of Guadalajara Health Sciences Center, Hospital 278, Guadalajara, Jalisco, Mexico
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5
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Brennan F, Stewart C, Burgess H, Davison SN, Moss AH, Murtagh FE, Germain M, Tranter S, Brown M. Time to Improve Informed Consent for Dialysis: An International Perspective. Clin J Am Soc Nephrol 2017; 12:1001-1009. [PMID: 28377472 PMCID: PMC5460710 DOI: 10.2215/cjn.09740916] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The literature reveals that current nephrology practice in obtaining informed consent for dialysis falls short of ethical and legal requirements. Meeting these requirements represents a significant challenge, especially because the benefits and risks of dialysis have shifted significantly with the growing number of older, comorbid patients. The importance of informed consent for dialysis is heightened by several concerns, including: (1) the proportion of predialysis patients and patients on dialysis who lack capacity in decision making and (2) whether older, comorbid, and frail patients understand their poor prognosis and the full implications to their independence and functional status of being on dialysis. This article outlines the ethical and legal requirements for a valid informed consent to dialysis: (1) the patient was competent, (2) the consent was made voluntarily, and (3) the patient was given sufficient information in an understandable manner to make the decision. It then considers the application of these requirements to practice across different countries. In the process of informed consent, the law requires a discussion by the physician of the material risks associated with dialysis and alternative options. We argue that, legally and ethically, this discussion should include both the anticipated trajectory of the illness and the effect on the life of the patient with particular regard to the outcomes most important to the individual. In addition, a discussion should occur about the option of a conservative, nondialysis pathway. These requirements ensure that the ethical principle of respect for patient autonomy is honored in the context of dialysis. Nephrologists need to be open to, comfortable with, and skillful in communicating this information. From these clear, open, ethically, and legally valid consent discussions, a significant dividend will hopefully flow for patients, families, and nephrologists alike.
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Affiliation(s)
- Frank Brennan
- Departments of Nephrology and
- Palliative Care, St. George Hospital, Sydney, New South Wales, Australia
| | - Cameron Stewart
- Faculty of Law, University of Sydney, Sydney, New South Wales, Australia
| | | | - Sara N. Davison
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Alvin H. Moss
- Sections of Nephrology and
- Supportive Care, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Fliss E.M. Murtagh
- Department of Palliative Care, Cecily Saunders Institute, King’s College London, London, United Kingdom; and
| | - Michael Germain
- Division of Nephrology, Tufts University, Springfield, Massachusetts
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6
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Morton RL, Webster AC, McGeechan K, Howard K, Murtagh FE, Gray NA, Kerr PG, Germain MJ, Snelling P. Conservative Management and End-of-Life Care in an Australian Cohort with ESRD. Clin J Am Soc Nephrol 2016; 11:2195-2203. [PMID: 27697783 PMCID: PMC5142079 DOI: 10.2215/cjn.11861115] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 07/28/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES We aimed to determine the proportion of patients who switched to dialysis after confirmed plans for conservative care and compare survival and end-of-life care among patients choosing conservative care with those initiating RRT. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A cohort study of 721 patients on incident dialysis, patients receiving transplants, and conservatively managed patients from 66 Australian renal units entered into the Patient Information about Options for Treatment Study from July 1 to September 30, 2009 were followed for 3 years. A two-sided binomial test assessed the proportion of patients who switched from conservative care to RRT. Cox regression, stratified by center and adjusted for patient and treatment characteristics, estimated factors associated with 3-year survival. RESULTS In total, 102 of 721 patients planned for conservative care, and median age was 80 years old. Of these, 8% (95% confidence interval, 3% to 13%), switched to dialysis, predominantly for symptom management. Of 94 patients remaining on a conservative pathway, 18% were alive at 3 years. Of the total 721 patients, 247 (34%) died by study end. In multivariable analysis, factors associated with all-cause mortality included older age (hazard ratio, 1.55; 95% confidence interval, 1.36 to 1.77), baseline serum albumin <3.0 versus 3.7-5.4 g/dl (hazard ratio, 4.31; 95% confidence interval, 2.72 to 6.81), and management with conservative care compared with RRT (hazard ratio, 2.18; 95% confidence interval, 1.39 to 3.40). Of 247 deaths, patients managed with RRT were less likely to receive specialist palliative care (26% versus 57%; P<0.001), more likely to die in the hospital (66% versus 42%; P<0.001) than home or hospice, and more likely to receive palliative care only within the last week of life (42% versus 15%; P<0.001) than those managed conservatively. CONCLUSIONS Survival after 3 years of conservative management is common, with relatively few patients switching to dialysis. Specialist palliative care services are used more frequently and at an earlier time point for conservatively managed patients, a practice associated with better symptom management and quality of life.
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Affiliation(s)
- Rachael L. Morton
- National Health and Medical Research Council Clinical Trials Centre, Sydney Medical School and
| | - Angela C. Webster
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Fliss E.M. Murtagh
- Cicely Saunders Institute, King’s College London, Denmark Hill, United Kingdom
| | - Nicholas A. Gray
- Sunshine Coast Clinical School, The University of Queensland and Renal Unit, Nambour General Hospital, Nambour, Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Medical Centre, Clayton, Australia
| | - Michael J. Germain
- Department of Medicine, Division of Nephology, Baystate Medical Center, Springfield, Massachusetts; and
| | - Paul Snelling
- Department of Renal Medicine Royal Prince Alfred Hospital, Camperdown, Australia
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7
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Abstract
Comprehensive conservative (nondialytic) kidney care is widely recognized and delivered but until recently, has not been clearly defined. We provide a clear definition of comprehensive conservative care. This includes interventions to delay progression of kidney disease and minimize complications as well as detailed communication, shared decision making, advance care planning, and psychologic and family support. It does not include dialysis. Limited epidemiologic evidence from Australia and Canada indicates that, for every new person diagnosed with ESRD who receives dialysis or transplant, there is one new person who is managed conservatively (either actively or not). For older patients (those >75 or 80 years old) who have higher levels of comorbidity (such as diabetes and heart disease) and poorer functional status, the survival advantage of dialysis may be limited, and comprehensive conservative management may be considered; however, robust comparative evidence remains limited. Considerations of symptoms, quality of life, and hospital-free days are as or sometimes more important for patients and families than survival. There is some evidence that communication about possible conservative management options is generally insufficient, even where comprehensive conservative care pathways are already established. Symptom control and the cost-effectiveness of interventions are addressed in the companion papers within this Moving Points in Nephrology series. There is almost no evidence about which models of care and which interventions might be most beneficial in this population; future research on these areas is much needed. Meanwhile, consistency in definition of comprehensive conservative care and basing interventions on existing evidence about survival, symptoms, quality of life, and experience will maximize patient-centered and holistic care.
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Affiliation(s)
- Fliss E.M. Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, United Kingdom
| | - Aine Burns
- Department of Nephrology, Royal Free Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Olivier Moranne
- Institut Universitaire de Recherche Clinique, EA2415, Epidémiologie, Biostatistiques et santé publique, Faculté de Médecine, Université de Montpellier, Montpellier, France
- Nephrology and Dialysis Department, Centre Hospitalier Universitaire de Nimes, Nimes, France
| | - Rachael L. Morton
- National Health and Medical Research Centre Clinical Trials Centre, University of Sydney, Sydney, Australia; and
| | - Saraladevi Naicker
- Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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8
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Daveson BA, Smith M, Yi D, McCrone P, Grande G, Todd C, Gysels M, Costantini M, Murtagh FE, Higginson IJ, Evans CJ. The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers. Hippokratia 2016. [DOI: 10.1002/14651858.cd011619.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Barbara A Daveson
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Melinda Smith
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Deokhee Yi
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Paul McCrone
- King's College London; Institute of Psychiatry; Box P024 De Crespigny Park London UK SE5 8AF
| | - Gunn Grande
- University of Manchester; School of Nursing, Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester Greater Manchester UK M13 9PL
| | - Chris Todd
- University of Manchester; School of Nursing, Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester Greater Manchester UK M13 9PL
| | - Marjolein Gysels
- University of Amsterdam; Amsterdam Institute of Social Science Research; Amsterdam Netherlands
| | - Massimo Costantini
- IRCCS Arcispedale S. Maria Nuova; Palliative Care Unit; Reggio Emilia Italy
| | - F E Murtagh
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Irene J Higginson
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
| | - Catherine J Evans
- King's College London; Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute; London UK
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Breckenridge K, Bekker HL, Gibbons E, van der Veer SN, Abbott D, Briançon S, Cullen R, Garneata L, Jager KJ, Lønning K, Metcalfe W, Morton RL, Murtagh FE, Prutz K, Robertson S, Rychlik I, Schon S, Sharp L, Speyer E, Tentori F, Caskey FJ. How to routinely collect data on patient-reported outcome and experience measures in renal registries in Europe: an expert consensus meeting. Nephrol Dial Transplant 2015; 30:1605-14. [PMID: 25982327 PMCID: PMC4569391 DOI: 10.1093/ndt/gfv209] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 04/13/2015] [Indexed: 11/14/2022] Open
Abstract
Despite the potential for patient-reported outcome measures (PROMs) and experience measures (PREMs) to enhance understanding of patient experiences and outcomes they have not, to date, been widely incorporated into renal registry datasets. This report summarizes the main points learned from an ERA-EDTA QUEST-funded consensus meeting on how to routinely collect PROMs and PREMs in renal registries in Europe. In preparation for the meeting, we surveyed all European renal registries to establish current or planned efforts to collect PROMs/PREMs. A systematic review of the literature was performed. Publications reporting barriers and/or facilitators to PROMs/PREMs collection by registries were identified and a narrative synthesis undertaken. A group of renal registry representatives, PROMs/PREMs experts and patient representatives then met to (i) share any experience renal registries in Europe have in this area; (ii) establish how patient-reported data might be collected by understanding how registries currently collect routine data and how patient-reported data is collected in other settings; (iii) harmonize the future collection of patient-reported data by renal registries in Europe by agreeing upon preferred instruments and (iv) to identify the barriers to routine collection of patient-reported data in renal registries in Europe. In total, 23 of the 45 European renal registries responded to the survey. Two reported experience in collecting PROMs and three stated that they were actively exploring ways to do so. The systematic review identified 157 potentially relevant articles of which 9 met the inclusion criteria and were analysed for barriers and facilitators to routine PROM/PREM collection. Thirteen themes were identified and mapped to a three-stage framework around establishing the need, setting up and maintaining the routine collection of PROMs/PREMs. At the consensus meeting some PROMs instruments were agreed for routine renal registry collection (the generic SF-12, the disease-specific KDQOL™-36 and EQ-5D-5L to be able to derive quality-adjusted life years), but further work was felt to be needed before recommending PREMs. Routinely collecting PROMs and PREMs in renal registries is important if we are to better understand what matters to patients but it is likely to be challenging; close international collaboration will be beneficial.
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Affiliation(s)
| | - Hillary L. Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Elizabeth Gibbons
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Sabine N. van der Veer
- European Renal Best Practice, Methods Support Team, University Hospital Ghent, Ghent, Belgium
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, Manchester, UK
| | - Denise Abbott
- The National Kidney Federation, Shireoaks, Worksop, UK
| | - Serge Briançon
- CHU de Nancy, Epidémiologie et évaluation cliniques, Inserm CIC 1433, Nancy, France
| | - Ron Cullen
- UK Renal Registry, Southmead Hospital, Bristol, UK
| | - Liliana Garneata
- ‘Dr Carol Davila’ Teaching Hospital of Nephrology, Bucharest, Romania
| | - Kitty J. Jager
- European Renal Association–European Dialysis and Transplant Association Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kjersti Lønning
- Section of Nephrology, Department of Organ Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Wendy Metcalfe
- Renal Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
- The Scottish Renal Registry, Glasgow, UK
| | - Rachael L. Morton
- School of Public Health, The University of Sydney, Sydney, Australia
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Headington, UK
| | - Fliss E.M. Murtagh
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Cicely Saunders Institute, London, UK
| | - Karl Prutz
- Swedish Renal Registry, Jönköping, Sweden
- Department of Internal Medicine, Hospital of Helsingborg, Helsingborg, Sweden
| | | | - Ivan Rychlik
- 2nd Department of Medicine, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steffan Schon
- Swedish Renal Registry, Jönköping, Sweden
- Diaverum Renal Services Group, Lund, Sweden
| | - Linda Sharp
- National Cancer Registry Ireland, Cork, Ireland
| | - Elodie Speyer
- CHU Nancy, Pôle QSP2, Epidémiologie et Evaluation Cliniques, Nancy, France
- Université de Lorraine, Université Paris Descartes, Nancy, France
| | | | - Fergus J. Caskey
- UK Renal Registry, Southmead Hospital, Bristol, UK
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Daveson BA, Smith M, Yi D, McCrone P, Grande G, Todd C, Gysels M, Costantini M, Murtagh FE, Higginson IJ, Evans CJ. The effectiveness and cost-effectiveness of inpatient specialist palliative care in acute hospitals for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2015. [DOI: 10.1002/14651858.cd011619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Murtagh FE, Iris Groeneveld E, Kaloki YE, Calanzani N, Bausewein C, Higginson IJ. Capturing activity, costs, and outcomes: The challenges to be overcome for successful economic evaluation in palliative care. Progress in Palliative Care 2013. [DOI: 10.1179/1743291x12y.0000000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Murtagh FE, Spagnolo AG, Panocchia N, Gambaro G. Conservative (non dialytic) management of end-stage renal disease and withdrawal of dialysis. Progress in Palliative Care 2013. [DOI: 10.1179/096992609x12455871937143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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13
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Murtagh FE, Cohen LM, Germain MJ. The "no dialysis" option. Adv Chronic Kidney Dis 2011; 18:443-9. [PMID: 22098664 DOI: 10.1053/j.ackd.2011.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 10/24/2011] [Accepted: 10/24/2011] [Indexed: 11/11/2022]
Abstract
Increasing numbers of patients are starting dialysis who have limited prognoses for 6-month survival. The presence of multiple comorbidities, aging, and frailty contributes to this phenomenon. The rate of dialysis withdrawal has been accelerating over the past decade, and this calls into question the condition of patients who are initiating dialysis. One option is to consider and discuss the "no dialysis" option with patients and family. Patients need to be identified who may benefit from this option, and their medical management needs to be reviewed.
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Murtagh FE, Addington-Hall JM, Higginson IJ. End-Stage Renal Disease: A New Trajectory of Functional Decline in the Last Year of Life. J Am Geriatr Soc 2011; 59:304-8. [DOI: 10.1111/j.1532-5415.2010.03248.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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