Patient and Physician Perspectives on Use of Patient-Reported Outcome Measures in Non-Dialysis-Dependent CKD Care: A Qualitative Study.

RATIONALE &

OBJECTIVE

People with non-dialysis-dependent chronic kidney disease (NDD-CKD) can experience substantial symptoms related to physical and mental health. Patient-reported outcome measures (PROMs) assess these aspects of health-related quality of life (QOL). Using the Kidney Disease Symptom Survey as an example to guide discussions, we sought to understand perspectives of patients and nephrology physicians about using PROMs in routine NDD-CKD care.

STUDY

DESIGN

Individual semi-structured interviews informed by the Theoretical Domains Framework and associated Capability, Opportunity, Motivation model of behavior change.

SETTING &

PARTICIPANTS

Adults with NDD-CKD and nephrology physicians in the Greater Baltimore-Maryland region.

ANALYTICAL APPROACH: Hybrid inductive-deductive thematic analysis.

RESULTS

We analyzed interview transcripts from 15 nephrology physicians and 21 people with NDD-CKD. Capability to use PROMs was hindered by limited knowledge and skills of nephrology care teams to act on PROM results and manage symptoms. Opportunity to use PROMs was influenced by concerns surrounding environmental resources, including limited accessibility of PROMs to select patient users and limited time available to physicians to review PROMs data. Participants believed that PROMs could guide person-centered care, but motivation to use them was impeded by the uncertain role of nephrology physicians in assessing and managing symptoms and QOL, as well as concerns that PROMs may capture symptoms unrelated to CKD while also lacking sensitivity for key issues relevant to CKD patient care.

LIMITATIONS: Impact of clinical practice setting (including the availability of multidisciplinary support) and the views of individual PROM domains was not assessed.

CONCLUSIONS

Patient and clinician participants recognized the importance of symptom and QOL assessment in nephrology care. However, behavior changes required to integrate PROMs into routine CKD care may be limited by barriers related to the capability, opportunity, and motivation of users. These findings can inform the development of programs which support PROM implementation.