• An assessment of symptoms that was incorporated into routine care for patients undergoing hemodialysis successfully standardized symptom screening processes, improved patient and provider symptom awareness, and empowered patients to raise issues with providers.
  • There was little, if any, improvement in the metrics used to assess symptom management, communication between patients and providers, and communication among different types of clinicians.

Newswise — Washington, DC (August 25, 2020) — Results from a new study indicate that routinely assessing symptoms in patients with kidney failure who are undergoing hemodialysis can empower patients in their discussions with their healthcare providers. Greater efforts are needed to help providers manage these symptoms, however. The findings appear in an upcoming issue of CJASN.  

Although hemodialysis is a life-sustaining treatment for individuals with kidney failure, patients frequently experience symptoms of fatigue, pain, sleeplessness, anxiety, and depression. These symptoms can greatly affect quality of life, but they are often under-recognized, under-estimated, and under-treated by clinicians who care for patients undergoing hemodialysis.

A team led by Michael Walsh, MD, PhD and Jenna Evans, PhD (McMaster University, in Ontario, Canada) designed a study to examine the perspectives of patients and care providers when an assessment of these symptoms was incorporated into routine care. “After the assessment was made part of usual care, patients and their healthcare providers completed surveys and interviews to help us understand how this approach helps and where it falls short,” Dr. Walsh explained. “This is important because several groups are lobbying for the routine use of patient-reported outcomes in the care of patients undergoing hemodialysis, but there are very little data to guide their best use and demonstrate how they might improve care.”

The study was conducted in 8 hemodialysis clinics in Canada, and the assessments were made for 1,459 patients every 4 to 6 weeks for a year. Most patients completed surveys, and 9 patients/caregivers from 3 sites and 48 healthcare providers from all sites participated in interviews.

The investigators found that the standardized symptom screening processes improved patient and provider symptom awareness (particularly for psychosocial symptoms), and empowered patients to raise issues with providers. Yet there was little, if any, improvement in the metrics used to assess symptom management, communication between patients and providers, and communication among different types of clinicians.

“The study found that although routinely assessing symptoms gave some patients a feeling of empowerment to discuss symptoms they otherwise would not have, their care providers need more support to help their patients,” said Dr. Walsh. “Care providers found value in the process but felt that we administered it too frequently and that they needed better support to help them manage symptoms both in terms of training and education, but also in terms of ensuring the right resources are in place at the right time.”

An accompanying editorial noted that the findings “reinforce the feasibility of using patient-reported outcome measures in clinical practice while providing important lessons to guide future work to realize their potential.”

Study co-authors include Alysha Glazer, MPH, Rebecca Lum, MSc, Esti Heale, MBA, Marnie MacKinnon, BPE, and Peter G. Blake, MD, FRCPC.

Disclosures: P.G. Blake reports working part time at the Ontario Renal Network (ORN), part of Ontario Health, while contributing to this work and receiving speaking honoraria from Baxter Global outside the submitted work. All remaining authors have nothing to disclose.

The article, titled “Implementing a patient-reported outcome measure for hemodialysis patients in routine clinical care: Perspectives of patients and providers on ESAS-r:Renal,” will appear online at http://cjasn.asnjournals.org/ on August 25, 2020, doi: 10.2215/CJN.01840220.

The editorial, titled “A Step in the Right Direction: The promise of PROMs in Routine Hemodialysis Care,” will appear online at http://cjasn.asnjournals.org/ on August 25, 2020, doi: 10.2215/CJN.12350720.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Since 1966, ASN has been leading the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients. ASN has more than 21,000 members representing 131 countries. For more information, visit www.asn-online.org.

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