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Clinicians' and researchers' perspectives on establishing and implementing core outcomes in haemodialysis:
Allison Tong1,2, Sally Crowe3, John S Gill4
1Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.
Objectives:
To describe the perspectives of clinicians and researchers on identifying, establishing and implementing core outcomes in haemodialysis and their expected impact.
Design:
Face-to-face, semistructured interviews; thematic analysis.
Stetting:
Twenty-seven centres across nine countries.
Participants:
Fifty-eight nephrologists (42 (72%) who were also triallists).
Results:
We identified six themes: reflecting direct patient relevance and impact (survival as the primary goal of dialysis, enabling well-being and functioning, severe consequences of comorbidities and complications, indicators of treatment success, universal relevance, stakeholder consensus); amenable and responsive to interventions (realistic and possible to intervene on, differentiating between treatments); reflective of economic burden on healthcare; feasibility of implementation (clarity and consistency in definition, easily measurable, requiring minimal resources, creating a cultural shift, aversion to intensifying bureaucracy, allowing justifiable exceptions); authoritative inducement and directive (endorsement for legitimacy, necessity of buy-in from dialysis providers, incentivising uptake); instituting patient-centredness (explicitly addressing patient-important outcomes, reciprocating trial participation, improving comparability of interventions for decision-making, driving quality improvement and compelling a focus on quality of life).
Conclusions:
Nephrologists emphasised that core outcomes should be relevant to patients, amenable to change, feasible to implement and supported by stakeholder organisations. They expected core outcomes would improve patient-centred care and outcomes.