Clinical impact of patient‐centered care for hemodialysis patients using routine assessment of symptom burden

Abstract

The study aimed to verify the impact of our clinical strategy, which emphasizes patient-centered care, based on patient-reported outcome measures (PROMs) results in hemodialysis patients. We developed our original PROM (comprising 20 items) to assess patients' symptom burden. To confirm the validity of our clinical pattern, we performed various analyses using PROM data. We retrospectively enrolled 383 individuals (mean age 66.3 years; 252 men), collected their PROM data in December 2013, and followed them up for 3 years. We noted a lower mortality rate and a lower prevalence of itching in our facilities than in previous surveys and reports in Japan. Furthermore, we observed that the severity of symptom burden affected medium-term prognosis. This is the first study to report the results of patient-centered medical practice utilizing PROMs in dialysis care. Careful attention should be paid to patients' symptom burden, as performed in objective data management.

Patient-Centered Care Could Improve Quality of Life and Survival of Dialysis Patients: Dialysis Prescription and Daily Practice

“…So far, the dialysis prescription, such as dialysis schedule, dialysis efficacy, usage of online HDF, and membrane choice, has been adjusted for each patient based on EBM, and only a few practice patterns center around the dialysis patients' PROs. In 2005, we initiated the concept of “patient-oriented dialysis (POD).” This concept includes two basic components: first, adjusting dialysis prescriptions based on PROs; and second, providing nutritional interventions based on a global nutritional assessment [ 12 , 13 , 14 , 15 ].…”

“…The original assessment sheet called “Ai-POD sheet” has been used for assessing the patient's symptom burden, which contains 20 questions for dialysis-related symptoms and feelings in our facilities shown in Table 1 . Each symptom was evaluated by a 5-graded face scale (0: none – 4: extreme), and the overall Ai-POD score was calculated [ 14 , 15 ]. After the routine examination with the Ai-POD sheet performed every 6 months, a meeting was held to identify patients needing interventions and discuss the treatment.…”

“…We reported that the severity of symptoms in hemodialysis patients, as measured by the Ai-POD score, is closely related to mortality risk [ 15 ]. Ten dialysis-related symptoms and feelings were identified as independent mortality risk factors: irritable feeling, fatigue, constipation, intradialytic hypotension, muscle cramp, difficulty getting up after dialysis, poor appetite, enjoyment of a meal, thirst, and dissatisfied feelings [ 15 ]. Some of them have already been reported as independent mortality risk factors, while others have not yet been reported.…”

“…One more possible mechanism of the survival advantage of PMMA could be associated with improving PROs and health-related QoL. Indeed, there are several reports of PMMA improving some of the PROs, and we already reported that the lower satisfied PROs were associated with a lower survival rate [ 15 ].…”

“…Although pruritus was not identified as an independent mortality risk factor in the DOPPS study, it is considered to deteriorate sleep quality and QoL, ultimately leading to poor outcomes [ 37 ]. Similar to DOPPS, our experience also demonstrated that the total PROs score was a risk factor for mortality, but itchy skin was not identified as an independent risk factor [ 15 ]. Aucella et al [ 38 ] reported that BG ameliorated skin itchiness in a preliminary study.…”