A SWIFT Approach: Clinician insights on the use of electronic patient-reported outcome measures in Nephrology

Abstract

Background: The Symptom monitoring WIth Feedback Trial (SWIFT) is a national registry-based randomized-control trial assessing the clinical outcomes and cost-effectiveness of using the Integrated Palliative care Outcome Scale (IPOS)-Renal measure for symptom monitoring in adults on haemodialysis. Despite evidence supporting patient-reported outcome measures (PROMs) in nephrology, effective implementation remains challenging. This study explores clinicians' perspectives on using electronic PROMs (ePROMs) in a haemodialysis context before and after implementing ePROMs as part of SWIFT.   Method: Semi-structured interviews with clinicians were conducted to explore the acceptability and feasibility of collecting, interpreting, and acting on ePROMs, including quality of life and symptom burden. Interviews were conducted either before or after SWIFT implementation and thematically analyzed.   Findings: Nurses (n=12), nephrologists (n=14), renal supportive care physicians (n=3) and site trial co-ordinators (n=2) across Australia participated in semi-structured interviews (additional interviews ongoing). Preliminary findings include: 1) Lack of PROM data access led some clinicians to rely on verbal symptom monitoring and biomedical evaluations; 2) PROMs helped some clinicians reorient clinical care toward patient priorities; 3) Low adoption of ePROMs could be due to limited referral options for non-nephrology symptoms; 4) symptom monitoring practices were adapted across specific patient populations (culturally and linguistically diverse, Indigenous Peoples, frail patients).   Implications: Insights from SWIFT and our qualitative evaluation can guide ePROM implementation in other settings, highlighting barriers and enablers to collecting, interpreting, and actioning ePROM data in nephrology clinical settings and registries. This can inform how multidisciplinary care teams refer and manage symptoms that matter most to patients.