Symptom Monitoring: SMaRRT-HD
Improving Hemodialysis-Related Symptoms
What challenge are we trying to solve?
Hemodialysis is a life-saving treatment but often causes distressing symptoms. People treated with hemodialysis frequently report symptoms such as muscle cramps, itching, and fatigue, and these symptoms contribute to poor quality of life and hospitalizations. Research in patients with other chronic diseases show that frequently asking patients to report their symptoms using standardized questionnaires (patient-reported outcome measures) and helping medical providers follow up on reported symptoms can improve symptoms, quality of life, and health care use. In current hemodialysis practice in the United States, patients formally report their symptoms once a year on a quality of life survey, and there is no system to help medical providers follow up on the reported symptoms.
“When I got home from dialysis, I would have to sleep for a few hours before I could function. But that whole day was really done. After that, I could go about my chores or do what I had to do – but the next day, I would have to go through it all over again. So, it really sucks up your whole life.”
SMaRRT-HD Study Overview
The SMaRRT-HD Study, also known as “Comparative Effectiveness of Two Approaches to Symptom Monitoring in Hemodialysis” compares two approaches for monitoring and addressing symptoms among adult patients with kidney failure who are treated with hemodialysis. For the first approach patients use an electronic system (called SMaRRT-HD) twice a month to report their symptoms. The system sends alerts to their medical team at the dialysis clinic about the reported symptoms and gives suggestions about how to manage them. The system also provides reports that show patients and their medical team the reported symptoms over time. For the second approach patients complete a quality of life questionnaire that includes questions about symptoms once a year. The questionnaire does not have follow-up support like alerts, symptom management guidance, or reports. In addition, researchers will talk to patients, dialysis clinic personnel, and medical providers about their experiences using the electronic symptom monitoring system to learn about how to best use patient-reported outcome measures in dialysis care.
- Jenny Flythe, Co-Principal Investigator (UNC Chapel Hill)
- Laura Dember, Co-Principal Investigator (University of Pennsylvania)
- Darren DeWalt, Co-Investigator (UNC Chapel Hill)
- Derek Forfang, Co-Investigator (Patient)
- Laura Hanson, Co-Investigator (UNC Chapel Hill)
- Jesse Hsu, Co-Investigator (University of Pennsylvania)
- Mark Unruh, Co-Investigator (University of New Mexico)
- Virginia Wang, Co-Investigator (Duke University)
- Rebecca Wingard, Co-Investigator (Fresenius Medical Care)
- Rehnuma “Ria” Riana, Research Coordinator (UNC Chapel Hill)
- Patients and care partners
- Dialysis organization leaders
- Interdisciplinary care team representatives
- Professional and patient organizations
- Coming soon
- Concept elicitation (patient and clinic personnel interviews about symptoms)
- Cognitive testing (patient interviews about the draft symptom questionnaire)
- Pilot test (real-world implementation of SMaRRT-HD)
- Dialysis community research capacity (principles underlying our approach to stakeholder engagement)
- Coming soon
Patient-Centered Outcomes Research Institute (PCORI) Research Award (IHS-2021C2-23534)
Questions? Comments? We want to hear from you!