| Nephrology care teams have limited knowledge and skills to act on PROM results and manage symptoms |
Nephrology physicians are not trained in assessment and management of symptoms and QOL. |
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“I think the barrier for me is how do I make them better with those symptoms. And I may not have all the tools necessary to improve those symptoms. And that’s where I think we, as nephrologists, may fall short because we are not trained to manage those symptoms necessarily or even to make a good diagnosis of why they have those symptoms.” (physician 1, JH academic practice)
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“I feel like we’re pretty good at diagnosing. But, as far as managing the symptoms, in terms of if I need to prescribe any antidepressants or anything like that, I don’t think I’m the right person to do that. In that case, it would be definitely helpful if I have a psychiatrist on board who's obviously more in tune with the treatment options than I am.” (physician 10,
independent
practice)
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| Multidisciplinary/-interdisciplinary support is needed to assist both patients and physicians in managing all aspects of PROMs. |
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“I do feel that patients with chronic kidney disease, they are complex. They have multiple competing symptoms and demands. And having a multidisciplinary team or people who would be well-equipped in assessing the symptoms and, as you said, not only physical but quality of life and mental health, I think that would be potentially beneficial for patients with CKD to address their symptoms, and help them navigate the system, and have a higher quality of life.” (physician 13,
non-JH
academic)
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“I feel, in terms of quality of life, easier access to allied health professional support, social work support, nutrition, definitely, palliative. So having a team to address multiple issues that sometimes it’s a little bit hard to be handled by the physician alone, I think, helps. Even simple nursing support. Because every contact the patient has with the health care system is usually an additional support for the patient…” (physician 15, JH academic practice)
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“…if they had a specialist, where their whole job was to check in on all the kidney care patients. Here’s what it is. Here’s what you answered in your symptom survey. How are those going for you? Let’s find some solutions. You can do either changes in your daily life, in your routine, or changes in over-the-counter medications can be very helpful. Like, do you need Tylenol. Do you need laxatives? Do you need anti-diarrheal medications? How do we connect you with the supplies that you need and to make sure that they have the resources to get those supplies and all that kind of thing, like just somebody whose whole job is to make somebody feel welcomed and comfortable, would be a game-changer. It would be fantastic.” (patient 1, CKD G5)
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