Rachael C Walker1, Allison Tong2,3, Kirsten Howard3, Suetonia C Palmer4,5. 1. Eastern Institute of Technology, Hawke's Bay, New Zealand. 2. Centre for Kidney Research, The Children's Hospital at Westmead, Australia. 3. Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Australia. 4. Department of Medicine, University of Otago, Christchurch, New Zealand. 5. Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand.
Abstract
BACKGROUND: Fear of catastrophic events and uncertainty about safety at home are barriers to choosing peritoneal dialysis (PD). Remote monitoring may address these concerns and is increasingly being used in patients on automated peritoneal dialysis (APD). This study aims to describe clinicians' perspectives and experiences of remote monitoring in caring for patients on PD. METHODS: We conducted semi-structured interviews with nephrologists and dialysis nurses across nine dialysis units in New Zealand who had experience using remote monitoring with patients on APD. Interviews were transcribed and analysed using thematic analysis. RESULTS: Thirteen registered nurses and 12 nephrologists or nephrologists-in-training (total N = 25) participated. Four themes were identified: promoting and maintaining PD (providing reassurance to patients through continual surveillance, supporting confidence at home and sustaining PD as the patient-preferred treatment); enabling data-driven decisions (using comprehensive clinical data in providing timely and accessible care, and identifying and supporting patient adherence); establishing boundaries for use (negotiating privacy and independence, clarifying clinician and patient responsibilities and strengthening nursing innovation and capability); and enhancing patient-focused care (developing empathy for patients, enabling self-management and reducing time and financial burden in accessing care). CONCLUSIONS: Remote monitoring is valued by clinicians in promoting and maintaining patients on PD and enabling data-driven decisions. Remote monitoring enhances patient-focused care, but clinicians also emphasise the need to protect patient privacy and establish boundaries for use. Remote monitoring that supports the clinicians' role and adheres to principles of data security maintains patient privacy may enhance care and outcomes for patients on PD.
BACKGROUND: Fear of catastrophic events and uncertainty about safety at home are barriers to choosing peritoneal dialysis (PD). Remote monitoring may address these concerns and is increasingly being used in patients on automated peritoneal dialysis (APD). This study aims to describe clinicians' perspectives and experiences of remote monitoring in caring for patients on PD. METHODS: We conducted semi-structured interviews with nephrologists and dialysis nurses across nine dialysis units in New Zealand who had experience using remote monitoring with patients on APD. Interviews were transcribed and analysed using thematic analysis. RESULTS: Thirteen registered nurses and 12 nephrologists or nephrologists-in-training (total N = 25) participated. Four themes were identified: promoting and maintaining PD (providing reassurance to patients through continual surveillance, supporting confidence at home and sustaining PD as the patient-preferred treatment); enabling data-driven decisions (using comprehensive clinical data in providing timely and accessible care, and identifying and supporting patient adherence); establishing boundaries for use (negotiating privacy and independence, clarifying clinician and patient responsibilities and strengthening nursing innovation and capability); and enhancing patient-focused care (developing empathy for patients, enabling self-management and reducing time and financial burden in accessing care). CONCLUSIONS: Remote monitoring is valued by clinicians in promoting and maintaining patients on PD and enabling data-driven decisions. Remote monitoring enhances patient-focused care, but clinicians also emphasise the need to protect patient privacy and establish boundaries for use. Remote monitoring that supports the clinicians' role and adheres to principles of data security maintains patient privacy may enhance care and outcomes for patients on PD.
Authors: Benjamin Talbot; Sara Farnbach; Allison Tong; Steve Chadban; Shaundeep Sen; Vincent Garvey; Martin Gallagher; John Knight Journal: Can J Kidney Health Dis Date: 2022-03-21