POS-517 IMPLEMENTING PATIENT-REPORTED OUTCOME MEASURES IN ROUTINE HEMODIALYSIS CARE: A QUALITATIVE STUDY OF PATIENT AND HEALTHCARE PROVIDER PERCEPTIONS

Abstract

Patient-reported outcome measures (PROMs) are questionnaires that enable patients to self-report symptoms and quality of life. While PROMs can help individualize management in chronic disease settings, it is unclear how to optimally integrate them in the care of people with complex chronic diseases, including those receiving chronic hemodialysis. The aim of this study was to explore the perceptions of healthcare providers and patients surrounding the implementation of PROMs and symptom management protocols for people undergoing hemodialysis. In this qualitative descriptive study, we purposively sampled across 10 outpatient hemodialysis centres in Southern Alberta that were part of the “Evaluation of routinely Measured PATient reported outcomes in HemodialYsis care” (EMPATHY) pragmatic, cluster randomized controlled trial. We used the Consolidated Framework for Implementation Research to inform data collection, which provides an approach to conceptualizing how the intervention, setting, individuals, and process might influence PROM implementation. We conducted semi-structured interviews with hemodialysis patients and healthcare providers and in-person observations of PROM administration during hemodialysis sessions. Data were coded in duplicate and analyzed using an inductive, thematic analysis approach. We interviewed 22 patients and 32 healthcare providers (21 nurses, 6 nephrologists, 5 allied health professionals) and conducted 19 observations of PROM-related interactions. Across participant types, PROM use was described as a means of formalizing hemodialysis care processes: “I feel it’s reflective of what we already do… but it seems more informal when we are doing it in our everyday [care]” (Nurse). Four themes related to PROM implementation within hemodialysis care processes emerged from the data: (1) Integrating PROMs within existing clinical rounding structures; (2) Creating additional opportunities for conversation about symptoms; (3) Establishing a process for symptom surveillance and follow-up; and (4) Retaining flexibility to adapt the process to suit site-specific needs. In this study, the implementation of PROMs with symptom management protocols in outpatient hemodialysis care provided a mechanism to formalize assessment and evaluation of patient’s symptoms into routine hemodialysis care processes. Sustaining PROM use should consider individual and contextual factors unique to the hemodialysis care setting.