Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

Neeru Agarwal; Karan K. Shah; Kathryn Dansie; Paul N.  Bennett; Lavern Greenham; Chris Brown; Brendan Smyth; Stephen McDonald; Shilpanjali Jesudason; Andrea K. Viecelli; Rachael L Morton; Fergus J Caskey

doi:10.1186/s12882-023-03399-5

Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

Neeru Agarwal^*
, Karan K. Shah
, Kathryn Dansie
, Paul N. Bennett
, Lavern Greenham
, Chris Brown
, Brendan Smyth
, Stephen McDonald
, Shilpanjali Jesudason
, Andrea K. Viecelli
, Rachael L Morton
, Fergus J Caskey

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

5 Citations (Scopus)

Abstract

Background
Patients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care.

Methods
This is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described.

Results
There were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months.

Conclusions
Electronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.

Original language	English
Article number	345
Journal	BMC Nephrology
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s12882-023-03399-5
Publication status	Published - 22 Nov 2023

Bibliographical note

Funding Information:
The SWIFT pilot is supported by a Kidney Health Australia Medical and Scientific Research Funding Grant (KHA2018-RM); a Jacquot Research Establishment Grant; a Princess Alexandra Research Foundation Research Grant; and a National Health and Medical Research Council (NHMRC) BEAT-CKD Program Grant (APP1092957). RLM is supported by an NHMRC Investigator Grant (APP1194703), and University of Sydney, Robinson Fellowship. BS is supported by a Jacquot Research Establishment Fellowship from the Royal Australasian College of Physicians. The funders played no role in the study design, data collection, analysis, reporting, or the decision to submit for publication.

Funding Information:
We thank the patient-partners in research design [who are not listed co-authors]; and gratefully acknowledge the participants, nursing, and medical staff for their support of this trial. Collaborators SWIFT Investigators include: Carmel Hawley (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David W Johnson (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David Harris (Department of Renal Medicine, Westmead, Australia), Lilliana Laranjo (University of Sydney, Australia), Cecile Couchoud (Agence de la biomédecine, REIN Registry, France), Fergus J Caskey (University of Bristol, UK), Suetonia Palmer (University of Otago, New Zealand), Matthew Jose (University of Tasmania, Australia), R. John Simes (University of Sydney, Australia), Braden Manns (University of Calgary, Canada), William Handke (Consumer Representative, Australia), Enrico Coiera (Macquarie University, Australia), Rebecca Mister (University of Sydney, Australia), Portia Westall (University of Sydney, Australia).

Publisher Copyright:
© 2023, The Author(s).

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Agarwal, N., Shah, K. K., Dansie, K., Bennett, P. N., Greenham, L., Brown, C., Smyth, B., McDonald, S., Jesudason, S., Viecelli, A. K., Morton, R. L., & Caskey, F. J. (2023). Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial. BMC Nephrology, 24(1), Article 345. https://doi.org/10.1186/s12882-023-03399-5

@article{17f1eb6a2c314d278a87df45d5a42109,

title = "Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial",

abstract = "Background Patients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70\%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants{\textquoteright} treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care. Methods This is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described. Results There were 226 unique participants who completed the e-PROMs (mean age 62 years, 69\% males, 78\% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54\% and 68\%, respectively, and 89\% and 97\% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months. Conclusions Electronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.",

author = "Neeru Agarwal and Shah, \{Karan K.\} and Kathryn Dansie and Bennett, \{Paul N.\} and Lavern Greenham and Chris Brown and Brendan Smyth and Stephen McDonald and Shilpanjali Jesudason and Viecelli, \{Andrea K.\} and Morton, \{Rachael L\} and Caskey, \{Fergus J\}",

note = "Funding Information: The SWIFT pilot is supported by a Kidney Health Australia Medical and Scientific Research Funding Grant (KHA2018-RM); a Jacquot Research Establishment Grant; a Princess Alexandra Research Foundation Research Grant; and a National Health and Medical Research Council (NHMRC) BEAT-CKD Program Grant (APP1092957). RLM is supported by an NHMRC Investigator Grant (APP1194703), and University of Sydney, Robinson Fellowship. BS is supported by a Jacquot Research Establishment Fellowship from the Royal Australasian College of Physicians. The funders played no role in the study design, data collection, analysis, reporting, or the decision to submit for publication. Funding Information: We thank the patient-partners in research design [who are not listed co-authors]; and gratefully acknowledge the participants, nursing, and medical staff for their support of this trial. Collaborators SWIFT Investigators include: Carmel Hawley (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David W Johnson (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David Harris (Department of Renal Medicine, Westmead, Australia), Lilliana Laranjo (University of Sydney, Australia), Cecile Couchoud (Agence de la biom{\'e}decine, REIN Registry, France), Fergus J Caskey (University of Bristol, UK), Suetonia Palmer (University of Otago, New Zealand), Matthew Jose (University of Tasmania, Australia), R. John Simes (University of Sydney, Australia), Braden Manns (University of Calgary, Canada), William Handke (Consumer Representative, Australia), Enrico Coiera (Macquarie University, Australia), Rebecca Mister (University of Sydney, Australia), Portia Westall (University of Sydney, Australia). Publisher Copyright: {\textcopyright} 2023, The Author(s).",

year = "2023",

month = nov,

day = "22",

doi = "10.1186/s12882-023-03399-5",

language = "English",

volume = "24",

journal = "BMC Nephrology",

issn = "1471-2369",

publisher = "BioMed Central Ltd",

number = "1",

}

Agarwal, N, Shah, KK, Dansie, K, Bennett, PN, Greenham, L, Brown, C, Smyth, B, McDonald, S, Jesudason, S, Viecelli, AK, Morton, RL & Caskey, FJ 2023, 'Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial', BMC Nephrology, vol. 24, no. 1, 345. https://doi.org/10.1186/s12882-023-03399-5

TY - JOUR

T1 - Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis

T2 - a registry-based cluster randomized pilot trial

AU - Agarwal, Neeru

AU - Shah, Karan K.

AU - Dansie, Kathryn

AU - Bennett, Paul N.

AU - Greenham, Lavern

AU - Brown, Chris

AU - Smyth, Brendan

AU - McDonald, Stephen

AU - Jesudason, Shilpanjali

AU - Viecelli, Andrea K.

AU - Morton, Rachael L

AU - Caskey, Fergus J

N1 - Funding Information: The SWIFT pilot is supported by a Kidney Health Australia Medical and Scientific Research Funding Grant (KHA2018-RM); a Jacquot Research Establishment Grant; a Princess Alexandra Research Foundation Research Grant; and a National Health and Medical Research Council (NHMRC) BEAT-CKD Program Grant (APP1092957). RLM is supported by an NHMRC Investigator Grant (APP1194703), and University of Sydney, Robinson Fellowship. BS is supported by a Jacquot Research Establishment Fellowship from the Royal Australasian College of Physicians. The funders played no role in the study design, data collection, analysis, reporting, or the decision to submit for publication. Funding Information: We thank the patient-partners in research design [who are not listed co-authors]; and gratefully acknowledge the participants, nursing, and medical staff for their support of this trial. Collaborators SWIFT Investigators include: Carmel Hawley (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David W Johnson (Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia), David Harris (Department of Renal Medicine, Westmead, Australia), Lilliana Laranjo (University of Sydney, Australia), Cecile Couchoud (Agence de la biomédecine, REIN Registry, France), Fergus J Caskey (University of Bristol, UK), Suetonia Palmer (University of Otago, New Zealand), Matthew Jose (University of Tasmania, Australia), R. John Simes (University of Sydney, Australia), Braden Manns (University of Calgary, Canada), William Handke (Consumer Representative, Australia), Enrico Coiera (Macquarie University, Australia), Rebecca Mister (University of Sydney, Australia), Portia Westall (University of Sydney, Australia). Publisher Copyright: © 2023, The Author(s).

PY - 2023/11/22

Y1 - 2023/11/22

N2 - Background Patients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care. Methods This is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described. Results There were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months. Conclusions Electronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.

AB - Background Patients with kidney failure on hemodialysis (HD) experience considerable symptom burden and poor health-related quality of life (HRQoL). There is limited use of patient reported outcome measures (PROMs) in facility HD units to direct immediate care, with response rates in other studies between 36 to 70%. The aim of this pilot study was to evaluate feasibility of electronic PROMs (e-PROMs) in HD participants, with feedback 3-monthly to the participants’ treating team, for severe or worsening symptoms as identified by the Integrated Palliative Outcome Scale (IPOS-Renal), with linkage to the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry, compared with usual care. Methods This is a registry-based cluster-randomized controlled pilot trial involving all adults receiving HD in 4 satellite units in Australia over a 6-month period. HD units were cluster randomized 1:1 to the control (HRQoL data collection only) or intervention arm (symptom monitoring with feedback to treating team every 3 months). Feasibility was assessed by participant response rate (percentage of eligible HD participants, including new incident participants, who completed the questionnaire at each time point); retention rate (percentage of participants who completed the baseline questionnaire and all subsequent measures); and completion time. HRQoL and symptom burden scores are described. Results There were 226 unique participants who completed the e-PROMs (mean age 62 years, 69% males, 78% White-European, median dialysis vintage 1.62 years). At 6 months, response rate and retention rate for the intervention arm were 54% and 68%, respectively, and 89% and 97% in the control arm. Median time to complete IPOS-Renal was 6.6 min (5.3, 10.1) at 3 months, and when combined with the outcome measure (EQ-5D-5L), the median time was 9.4 min (6.9, 13.6) at 6 months. Conclusions Electronic symptom monitoring among HD participants with feedback to clinicians is feasible. Variations in response and retention rates could be potentially explained by the lengthier questionnaire, and higher frequency of data collection time points for participants in the intervention arm. A definitive national RCT is underway.

U2 - 10.1186/s12882-023-03399-5

DO - 10.1186/s12882-023-03399-5

M3 - Article (Academic Journal)

C2 - 37993776

SN - 1471-2369

VL - 24

JO - BMC Nephrology

JF - BMC Nephrology

IS - 1

M1 - 345

ER -

Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

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