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Preliminary Testing of the Discussion of Patient Life Goals Patient-Reported Outcome Measure for Dialysis Facilities
Claudia Dahlerus1,2, Noelle E Carlozzi1,3, Katrina Price1,4
1University of Michigan, Kidney Epidemiology and Cost Center, Ann Arbor, MI.
Rationale & Objectives:
To test a new patient-reported outcome measure that assesses end-stage kidney disease (ESKD) maintenance dialysis patients' experience with life goals discussions with their dialysis facility care team.
Study Design:
Observational cross-sectional study. Survey data collected via REDCap, paper form or telephone in a convenience sample of patients with ESKD receiving maintenance dialysis in the United States.
Settings & Participants:
People aged 18 years or older with ESKD receiving maintenance hemodialysis or peritoneal dialysis in US dialysis facilities between the June and December 2020 study period.
Exposures:
Testing of 6 items providing the core quality assessment and 1 item measuring whether 1 or more members of the treatment team discussed life goals with the patient.
Outcomes:
Preliminary reliability and validity of the Discussion of Patient Life Goals survey (D-PaLS).
Analytic Approach:
Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory methods, including the graded response model (GRM) and differential item functioning (DIF).
Results:
Of 517 participants, 479 completed the survey via REDCap; 38 completed the survey via paper or telephone. EFA and CFA supported the unidimensionality of the 6 core items. GRM overall and item fit analyses and DIF analyses supported retention of all core items. Preliminary reliability data indicated very good internal consistency (Cronbach's alpha = 0.84). Known-groups validity was supported whereby individuals receiving home dialysis had more positive responses, than those receiving in-center hemodialysis.
Limitations:
Study participants were not fully representative of the US ESKD dialysis population.
Conclusions:
Preliminary analyses indicate the D-PaLS has excellent psychometric properties. The measure provides 2 important quality metrics: facilities' level of engagement talking with patients about their life goals and the percentage of patients reporting who on the treatment team talks with them about their life goals. Additional work is needed to establish comprehensive reliability and validity to support the clinical utility of this measure in patient care.
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