Facilitating person-centered patient participation in kidney care—a process evaluation of a quasi-experimental study incorporating a tool and training of local implementation teams

Abstract

Background. The transfer of innovations into healthcare is laden with challenges. Although healthcare professionals are expected to adopt and fulfil new policies, a more person-centered healthcare, with conditions allowing preference-based patient participation is anticipated. Methods. The aim of the study was to evaluate two implementation strategies for person-centered patient participation in kidney care, including dissemination of a clinical tool, and training and support of internal facilitators. Nine Swedish kidney care units participated in the study (August 2019–September 2021), strategically organized into: a control group (three sites, no support); a standard dissemination group (three sites, with a tool for patient participation and guidance disseminated to the site managers); and an implementation group (three sites, with the tool and guidance disseminated as above, plus a six-month support program for designated internal facilitators). This process evaluation was comprised of repeat interviews with managers (n = 10), internal facilitators (n = 5), recordings, and notes from the interventions, and Alberta Context Tool survey data (n = 78). Hybrid analyses comprised mixed methods: descriptive and comparative statistics, and qualitative descriptive analysis. Results. None of the control group sites addressed patient participation. While the standard dissemination sites’ managers received and appreciated the tool and the accompanying guidance package, they made no attempts to make further use of it. In the facilitated implementation group, five internal facilitators from three sites engaged in the support program. They welcomed the opportunity to learn about preference-based patient participation, and about implementation, including potentially enhanced opportunities for preference-based patient participation via the tool. Each site’s facilitators developed a separate strategy for the dissemination of the tool: the tool was used with a few patients in each site, and only some staff were involved. Although noting a general interest in improving patient participation, the internal facilitators described limited local support. Rather, they suggested a longer support program and more local backing and engagement. Conclusions. Facilitating person-centered patient participation is complex, given the need to address attitudes, beliefs, and behaviors. This study indicates slow uptake and change, and more efficient strategies are needed to ensure the fundamentals of care remain accessible to all.