Background
Methods
Study design
Sample and recruitment
Data collection
Online survey
Semi-structured interview
Data analysis
Quantitative
Qualitative
Results
Descriptive survey results
Survey demographic and clinic characteristics
Characteristic | Survey (n = 113) Number (%) | Interviews (n = 18) Number (%) |
---|---|---|
Respondent role in CKD clinic | ||
Nurse | 54 (47.8) | 5 (27.8) |
Social worker | 17 (15.0) | 8 (44.4) |
Nephrologist | 13 (11.5) | 2 (11.1) |
Manager | 10 (8.8) | 3 (16.7) |
Dietitian | 9 (8.0) | |
Support staff | 4 (3.5) | |
Pharmacist | 3 (2.7) | |
Other (i.e., Indigenous navigator) | 1 (0.9) | |
Respondent length of time in current position | ||
Less than 1 year | 15 (13.3) | |
1-5 years | 38 (33.6) | |
6-10 years | 28 (24.8) | |
More than 10 years | 32 (28.3) | |
Geographical region where clinic located | ||
British Columbia | 50 (44.2) | 5 (27.8) |
Alberta, Saskatchewan, Manitoba | 30 (26.6) | 6 (33.3) |
Ontario, Quebec | 20 (17.7) | 5 (27.8) |
Atlantic Canada | 9 (8.0) | 2 (11.1) |
Territories | 2 (1.8) | |
City size where clinic located | ||
Less than 100,000 | 35 (31) | |
100,000-499,999 | 35 (31) | |
500,000-1,000,000 | 8 (7.1) | |
More than 1,000,000 | 34 (30.1) | |
Type of CKD patients seen in clinica | ||
Primarily non-dialysis CKD: | ||
G1-G3b | 74 (65.5) | |
G4 and G5 Non-dialysis | 94 (83.2) | |
Other categories of kidney disease: | ||
G5D Hemodialysis | 41 (36.3) | |
G5D Peritoneal dialysis | 32 (28.3) | |
G5T Transplant | 21 (18.6) | |
Other (e.g., kidney stones, AKI, transplant donors) | 6 (5.3) | |
Unsure | 1 (0.9) | |
CKD clinic care team membersb | ||
Registered nurse | 111 (98.2) | |
Nephrologist | 107 (94.7) | |
Dietitian | 106 (93.8) | |
Social worker | 101 (89.4) | |
Support staff (e.g., Unit clerks, Renal technicians) | 67 (59.3) | |
Pharmacist | 65 (57.5) | |
Licensed practical nurse, Nursing assistant | 32 (28.3) | |
Nurse practitioner | 17 (15.0) | |
Kinesiologist | 3 (2.7) | |
Occupational therapist | 2 (1.8) | |
Other (e.g., Indigenous navigator, Psychologist) | 7 (6.2) |
Peer support program characteristics
Peer support processes
Qualitative findings
Inconsistent awareness of peer support opportunities | |
“Maybe once or twice since I’ve worked in the kidney clinic in the last 3 years that I can remember have I heard a nurse say, ‘I told this patient about the peer support program’. They might be doing it. I mean, we all work in the same office. I overhear a lot of their conversations, [but] I haven’t heard them talk about it. I don’t know if the nephrologists talk about it… I don’t think anyone else is talking about it except for me.” – Social worker 1 | |
“I wouldn’t say there’s a lot of awareness. There tends to be around some of the social workers and among those who know the program exists, and we certainly have the pamphlets out there and the information generally available. I wouldn’t say the nursing staff or the dietary staff or the admin staff would be aware of the scope of the program or how to get people connected with it.” – Social worker 3 | |
We don’t know enough about peer support programs and how to train somebody and all these kinds of things…I don’t know much about it; I’ve never attended or anything like that.” – Social worker 5 | |
“I know that they [peer support organization] have the telephone support and an internet program and then I have no idea what goes on in other areas of Canada, but in [city] there was a coffee group started that of course is on hold now because of the pandemic.” – Nurse 2 | |
“I’m not 100% sure of the differences…I think it’s basically the same idea where they you have a person [patient] who is interested in peer support, and then they match you up with someone who [they] think they would be compatible with.” – Manager 1 | |
Logistics of peer support integration in multi-disciplinary care | |
“We have 1500 patients and there’s one of me, and if I’m the only one who is talking about peer support, I can’t get to everyone… There [isn’t] always a lot of time for me to talk to people. I may be addressing their financial concerns and that is paramount in that moment, rather than being able to look into deeper at those people’s needs and even think about offering peer support.” – Social worker 1 | |
“I think it would be likely that they [patients] use a peer support program if they knew more about it and we were trying to refer everyone to it.”- Social worker 2 | |
“I mean it’s easy to go there [peer support group] and be a guest speaker but doing the recruiting and organizing of space and then mentorship of clients who are willing to be volunteers, that takes a lot of work. The people who are working in these [CKD] programs don’t have enough time to do it off the side of the desk. – Social worker 7 | |
“It’s sort of frustrating because there will be times where you think, ‘I really wish I could take your name and number and give [it] to this person’, or I could [say], ‘You two could get together and start a Facebook group’. But we can’t do that.” – Nurse 2 | |
“I think it [peer support] should be reintroduced because our [CKD] patients change over time…I think it [peer support] basically should be like something that they [clinic staff] check off every time, or it should be introduced periodically, ‘are you sure you now don’t need a bit of peer support.’ – Nephrologist 1 | |
Recognition of patient accessibility concerns | |
“[Peer support program] doesn’t have people who speak languages other than English, which is a huge barrier for people who don’t speak English, and we do have one or two buddies who speak another language besides English.” – Social worker 1 | |
“I haven’t asked, but my thoughts would be [patients] feeling overwhelmed with everything that’s going on. Whether it’s their health or work, just having to do one more thing we are asking them to do. I’ve spoken to a peer support volunteer where she says she hands out her phone number all the time to patients for them to call and she doesn’t even get phone calls.” – Social worker 8 | |
“Sometimes when we are dealing with things geographically in addition to ease with technology. Sometimes you are trying to help those people, but you can’t get it [peer support] to them because them can’t understand or don’t have access to those technologies… We don’t have those teleconference places where people can go into the hospital and use those resources, or they can’t go to the library and use them there.” – Nurse 1 | |
“I promoted that [coffee group] a lot…many didn’t want to drive in from 90 min away for one more thing or were 4 h away so that just won’t work, but really wishing that there was someone [peer] or something [program] that they could make use of.” – Nurse 2 | |
“We have people who don’t want the support and think that everything is okay.” – Manager 1 | |
Integrating support pathways | |
“I tend to see peer support as part of the team atmosphere. The CKD team’s role is managing the medical needs, psychosocial needs...peer support is more of an adjunct, another layer to the program of being able to answer the questions of what the actual patient experience might look like.” – Social worker 3 | |
“Our patient groups are in silos as well. We [CKD clinic staff] don’t really hear. It’s not often that our peritoneal dialysis folks will be interacting with our hemodialysis folks or they will be come over here [CKD clinic] and interact with our [patients], Even though we are a big department we are kind of on our own at the same time.” – Social worker 6 | |
“I think it would be really useful to liaise with [peer support organization] because they have put so much work and time into a formal program. Then connecting them with social work because they connect with the [organization] for funding support and so they do have a bit of an existing communication process.” – Nephrologist 2 | |
“I think that it would be a great thing to have someone [peer mentor] readily available… Prior to us moving to this location, if we had a patient that was struggling whether or not to get a fistula, there are particular patients that we know that would be more than willing to speak to patients and show them what their fistula looks like. We could easily find out, well, Jane Doe is on dialysis today, I’ll go and ask that person, ‘Can we have a look at your fistula?’ And if so, let’s go have a look.” – Nurse 3 | |
“We do have volunteers here as well. They don’t always come down to clinic, but I guess that is something they probably could start doing. You could do a little visit. It’s more up on our in-centre hemo[dialysis] where they provide a chat or provide tea or coffee… This is a way for them to keep connected with everybody. It would probably help to have them go down to [CKD] clinic and share a few stories, especially on our education days.” – Manager 2 |
Inconsistent awareness of peer support opportunities
Logistics of peer support integration in multi-disciplinary care
Recognition of patient accessibility concerns
Need for integrated support pathways
Barriers and facilitators to integrating peer support into CKD care
Rank | Barriers identified from survey | Total rank priority score | Top 5 qualitative barriers |
1 | Lack of access to program | 261 | 1. Limited awareness of peer support programs (13 participants) Reduced healthcare provider awareness of peer support programs available for individuals with CKD. “I don’t really know very much about it [peer support], honestly. I just knew that it was supposedly available and initially in some of the package information I had it was available, that they [patients] could reach out and be in touch with others.” – Nurse 1 2. Challenges of virtual formats (10 participants) Inability to identify and offer peer support to eligible patients due to reduced capacity for in-person encounters. “To put a damper on it, I really feel like this virus [COVID-19] kind of ruined those [peer support] possibilities.” – Social worker 6 3. Workload and competing priorities (9 participants) Restricted integration of peer support into CKD care resulting from large clinic rosters with accompanying workloads and competing priorities. “Some of the clinics are so huge, we may not be able to identify ahead of time which patients may particularly need [peer] support at that time.” – Nurse 3 4. Perceived patient hesitancy (6 participants) Perceived patient reluctance to initiate peer support conversations or encounters. “If I put myself in that [patient’s] place… It’s going to take me a while to feel comfortable. I would be very worried about [not] knowing what to say.” – Nurse 2 5. Lack of time and resources (5 participants) Need for adequate resources to promote, offer, and deliver peer support in CKD clinics. “You need to find some time in doing that [off] the side of your desk.” – Social worker 7 |
2 | Lack of awareness of peer support options | 255 | |
3 | Workload | 246 | |
4 | Lack of resources to provide patient | 193 | |
5 | Too much information to provide patients at clinic visits | 155 | |
6 | Lack of patient receptivity | 111 | |
7 | Limited staff receptivity | 37 | |
8 | Feeling uncomfortable talking to patients about peer support | 31 | |
Rank | Facilitators identified from survey | Total rank priority score | Top 5 qualitative facilitators |
1 | Leadership (e.g., local program champion) | 294 | 1. Collaborations between and within organizations (5 participants) Ability to collaborate with other programs and organizations offering peer support. “I know some other community units were interested [in peer support] and emailed me and asked additional questions. So some other programs picked up on it as well to try to initiate [it].” - Social worker 7 2. Systematic process for integrating peer support (5 participants) Having consistent processes in place for identifying, discussing, and referring patients to peer support. “We have two other social workers that will do the referrals as well, and sometimes a nurse might bring it our way and we follow it from there.” – Social worker 6 3. Staff receptivity (4 participants) Staff engagement in promoting and/or integrating peer support within their clinic. “I think for the social workers or whoever would be running the groups to keep it consistent and keep going, even if it didn’t work out once to not give up and to keep trying.” – Social worker 8 4. Patient motivation (4 participants) Patient interest to drive implementation and sustainability of a peer support program “There are some people that tend to be really keen, they really want to learn from others. They want more information. We thought there would be more interest and more likely people to attend.” - Social worker 1 5. Strong patient-provider relationships (3 participants) Reliance on trusting relationships between providers and patients for encouraging peer support. “We can make that connection not only through social work but through nursing with the patients that we are seeing and connect them with peer support.” – Nurse 3 |
2 | Training and preparation | 256 | |
3 | Availability of patient volunteers | 254 | |
4 | Assistance with inviting patients to peer support program | 204 | |
5 | Management support | 195 | |
6 | Funding support | 152 | |
7 | Close relationship with external organization | 133 | |
8 | Adequate space | 127 |