#2852 What changes can the use of the IEXPAC tool induce in the nurse consultation for advanced chronic kidney disease?

Résumé fourni par la source

Abstract Background Patient-centered care includes therapeutic education, participation, information, and patient experience (XPA). XPA refers to the interactions of individuals throughout their disease process across various healthcare services, influencing their perceptions. Enhancing patient care improves self-management and fosters engagement in the continuum of their healthcare journey. Multiple tools are available to quantify XPA, the IEXPAC (Instrument to Evaluate Chronic Patient Experience) is a validated tool designed to assess the patient experience in chronic disease care. It focuses on three key dimensions: productive interactions, the new relational model, and patient self-management. Using 11 core and 4 optional Likert-scale questions, IEXPAC provides a comprehensive evaluation of patient-centered care, emphasizing shared decision-making, communication, and care continuity. In chronic kidney disease (CKD) clinics, IEXPAC enables the identification of areas for improvement, promoting enhanced patient satisfaction and engagement. This tool offers valuable insights to refine healthcare delivery and support self-care management for CKD patients. Understanding XPA is not just important, but crucial in the context of advanced chronic kidney disease (CKD) and shared decision-making for renal replacement therapies (RRT). It's time to move beyond outdated concepts like satisfaction and focus on the patient's experience throughout their disease process. Aims Describe the results obtained using the IEXPAC questionnaire in a CKD unit. Define actions to implement in an CKD consultation based on XPA evaluation with the IEXPAC tool. Method This descriptive study of XPA was conducted at a tertiary hospital in January/February 2024. The study population included all patients who completed follow-up in the joint CKD consultation in 2023 and initiated RRT in the same year. Exclusion criteria were refusal to participate and inability to complete the questionnaire. The IEXPAC tool, available online and in a phone version, was used. It assesses three dimensions: productive interactions, new relational models, and patient self-management. The questionnaire includes 11+4 Likert-scale questions. An independent interviewer administered the questionnaires in the CKD consultation. The hospital's ethics committee approved the study, and verbal consent was obtained from participants. Results The sample included 66 patients, 60.6% male, with a mean age of 67.4 ± 15.7 years. Of these, 44% were prefrail, 33% were frail, and 28% required a caregiver. RRT modalities: 65% hemodialysis, 3% home hemodialysis, 12% peritoneal dialysis, and 19% kidney transplantation (living/cadaveric donor). Patients completed 92% of the questionnaires. Global XPA score: 7.13 ± 0.86. Subscores: productive interactions 7.87 ± 4.2; new relational model 4.7 ± 2.2; patient self-management 8.19 ± 1.37. Conclusion The overall XPA score for CKD patients was satisfactory. However, the "new relational model" dimension scored the lowest, highlighting the need to strengthen peer-mentoring programs and integrate new technologies into XPA. Implementing these programs in CKD consultations is essential to address patient needs, including launching group classes with expert patients and incorporating access to technological tools.

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