Kidney Care Centers Struggle to Align with What Patients Actually Want
An 18-month Swedish study reveals a persistent gap between how healthcare staff and kidney patients define meaningful participation in treatment decisions. Despite interventions to improve person-centered care, the misalignment persisted—suggesting that current efforts to engage patients in chronic disease management may need fundamental redesign to move beyond compliance toward genuine shared decision-making.
Originaltitel: Patient participation - 18 months of patient and staff perspectives in kidney care: A mixed methods study addressing the effects of facilitating staff person-centredness
<p>Rationale</p><p>Patient participation should encapsulate the individual's resources and needs, though such standards remain rationed for people living with a long-term health concern like kidney failure.</p><p>Aims</p><p>To illustrate what patient participation signified to patients and staff in kidney care, and whether an agreed or disagreed conceptualisation occurred over time, evaluating the influence of two study-specific interventions to facilitate more person-centred participation.</p><p>Method</p><p>By convergent mixed methods design across 9 units in Sweden, we repeated the following data collection at 3 time points over 18 months: semistructured interviews with patients and staff (n = 72), and structured reviews for accounts of participation in patient records (n = 240). Data were subjected to content analysis and descriptive statistics, respectively. The outcomes were appraised for changes over time besides the interventions to enhance attention to patients' participation: a clinical tool and guidance distributed to management, and additional local support, respectively.</p><p>Results</p><p>Both patients and staff described patient participation as a comprehension of the disease and its management in everyday life. Yet, patients accentuated participation as one's experiences being recognised, and mutual knowledge exchange. Instead, staff emphasised the patients managing their treatment. The health records primarily represented what staff do to support their notion of patient participation. No influence of the interventions was noted, but what signified patient participation was maintained over time.</p><p>Conclusion</p><p>Both patients and staff stress the importance of patient participation, although they focus on different elements. Further person-centred conduct warrants a shared conceptualisation and strategies addressing and scaffolding patients' preferences and means.</p>