Living well without dialysis: Patients’ and healthcare professionals’ evaluation of the innovative, online Conservative Kidney Management Pathway
Bibliographic record
Abstract
Introduction Conservative kidney management (CKM) is a non-dialysis treatment option for older end-stage kidney disease (ESKD) patients with multiple comorbidities and poor functional status. For such patients who are unlikely to benefit from dialysis, Alberta recently launched a CKM Pathway that standardizes CKM and focuses on preserving kidney function, managing ESKD symptoms and offering holistic psychosocial support to patients and families. The CKM Pathway was introduced in four kidney clinics through a guided implementation process with staff engagement and education. An evaluation was undertaken to assess the CKM Pathway in improving CKM through quantitative and qualitative measures. The focus of this thesis is on the qualitative evaluation of the CKM Pathway from the perspectives of patients/families and healthcare providers. Methods A qualitative descriptive design was used. Patients and healthcare providers at four kidney clinics in Edmonton and Red Deer participated. Individual in-depth interviews with CKM patients/families and semi-structured focus groups with staff were conducted, recorded and transcribed verbatim. Thematic analysis was done using line-by-line coding. Results Ten patient/family interviews with 16 participants and five focus groups with 25 healthcare providers were conducted across the four kidney clinics. Three patient/family themes were identified. The CKM Pathway: a) supported facilitated decision-making; b) provided effective CKM patient resources; and c) promoted patient-centered care. From the staff focus groups, three related themes were identified. The CKM Pathway: a) improved kidney clinic processes and patient care; b) addressed a gap in CKM resources; and c) facilitated shared care with community- based healthcare providers. iii Conclusion Themes show overlap between patients/families’ and healthcare providers’ evaluation of the CKM Pathway. Kidney clinic staff piloting the CKM Pathway felt it provided evidence-based, standardized care and CKM patients felt supported with the pathway’s tools and resources. Both felt the CKM Pathway facilitated patient-centered CKM by engaging primary care providers as partners. Future studies should evaluate the CKM Pathway from the community care providers’ perspective.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".