Abstract
BackgroundPatients undertaking long-term and chronic home hemodialysis (HHD) are subject to feelings of isolation and anxiety due to the absence of physical contact with their health care professionals and lack of feedback in regards to their dialysis treatments. Therefore, it is important for these patients to feel the “presence” of the health care professionals remotely while on hemodialysis at home for better compliance with the dialysis regime and to feel connected with health care professionals.ObjectiveThis study presents an HHD system design for hemodialysis patients with features to enhance patient’s perceived “copresence” with their health care professionals. Various mechanisms to enhance this perception were designed and implemented, including digital logbooks, emotion sharing, and feedback tools. The mechanism in our HHD system aims to address the limitations associated with existing self-monitoring tools for HHD patients.MethodsA field trial involving 3 nurses and 74 patients was conducted to test the pilot implementation of the copresence design in our HHD system. Mixed method research was conducted to evaluate the system, including surveys, interviews, and analysis of system data.ResultsPatients created 2757 entries of dialysis cases during the period of study. Altogether there were 492 entries submitted with “Very Happy” as the emotional status, 2167 entries with a “Happy” status, 56 entries with a “Neutral” status, 18 entries with an “Unhappy” status, and 24 entries with a “Very unhappy” status. Patients felt assured to share their emotions with health care professionals. Health care professionals were able to prioritize the review of the entries based on the emotional status and also felt assured to see patients’ change in mood. There were 989 entries sent with short notes. Entries with negative emotions had a higher percentage of supplementary notes entered compared to the entries with positive and neutral emotions. The qualitative data further showed that the HHD system was able to improve patients’ feelings of being connected with their health care professionals and thus enhance their self-care on HHD. The health care professionals felt better assured with patients’ status with the use of the system and reported improved productivity and satisfaction with the copresence enhancement mechanism. The survey on the system usability indicated a high level of satisfaction among patients and nurses.ConclusionsThe copresence enhancement design complements the conventional use of a digitized HHD logbook and will further benefit the design of future telehealth systems.
Highlights
End stage renal disease (ESRD) is the most severe form of chronic kidney disease (CKD), and patients suffering from this condition have poor life expectancy if left untreated
Patients felt assured to share their emotions with health care professionals
Health care professionals were able to prioritize the review of the entries based on the emotional status and felt assured to see patients’ change in mood
Summary
End stage renal disease (ESRD) is the most severe form of chronic kidney disease (CKD), and patients suffering from this condition have poor life expectancy if left untreated. 2 (page number not for citation purposes) such as respiration rate, heart rate [23], blood pressure, and blood glucose level [24], some of which are able to be captured by wearable sensors [25] while others rely on patients’ self-input [26]; (2) a dashboard for clinicians to view data through a Web interface or mobile interface enables authorized personnel to monitor the patients’ condition and facilitate remote diagnosis; and (3) a messaging function to provide reminders or alerts to both patients and physicians These systems are continuously being enhanced, but challenges remain to improve their clinical impact. Another concern is the battery life or energy consumption of the design, as continuous data collection and processing can impose on a phone’s battery runtime [27]
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