Development and validation of a measure to assess patient experience of needling of arteriovenous fistulas or grafts for haemodialysis access: the NPREM.
Currie Moore, Amanda Busby, Rebecca Flanagan, Helen Ellis-Caird, Faizan Awan, Tarsem Paul, Catherine Fielding, Kieran McCafferty, Sabine N van der Veer, Ken Farrington, David Wellsted
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引用次数: 0
Abstract
Background: Needling is a key step in haemodialysis. Research suggests that needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM).
Methods: We used mixed methods and co-production. All participants were adults with working fistulas/grafts from eight UK kidney centres. Phase 1 involved developing concepts and items: in interviews (n = 41), we explored patients' needling experience and identified key aspects of needling using thematic analysis. This informed the 98-item NPREM(v0.1). Phase 2 was piloting the measure: cognitive interviews (n = 16) assessed face validity. Items were amended or removed, yielding a 48-item NPREM(v0.2). A pilot survey (n = 183) examined initial psychometric properties. NPREM(v0.2) showed good internal consistency (Cronbach's alpha = 0.95). Review of analyses resulted in a 35-item NPREM(v0.3). Phase 3 involved evaluating the measure's dimensionality, validity and reliability: patients (n = 468) completed the NPREM(v0.3), Vascular Access Quality of Life (VASQoL), EuroQol 5-Dimension-5-Level (EQ-5D-5L) and Patient Activation Measure (PAM), with a sub-set completing a follow-up NPREM (n = 99). Items were evaluated with 28 items retained in the NPREM(v1.0). Confirmatory factor analysis confirmed a unidimensional model fit (comparative fit index = 0.899). Validity of the NPREM(v1.0) was good [convergent: VASQoL (r = 0.60) and overall experience (r = 0.79); divergent: EQ-5D (r = -0.31), EQ-5D visul analogue scale (r = 0.24) and PAM (r = 0.17)]. Test-retest scores were strongly correlated (r = 0.88), demonstrating high reliability. Known-groups validity was demonstrated between centre scores [range 5.21 (standard deviation 1.20) to 5.94 (0.75)].
Conclusion: The NPREM measures patient experience of needling for haemodialysis. It offers kidney services a means of assessing needling experience, informing patient-focused clinical and service improvements.
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Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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