Telemedicine in Advanced Kidney Disease and Kidney Transplant: A Qualitative Meta-Analysis of Studies of Patient Perspectives

Rationale & ObjectiveWhile the use of telemedicine has increased dramatically across disciplines, patient perspectives on telemedicine related to chronic kidney disease are not well understood. We systematically reviewed qualitative studies on patients with chronic kidney disease as well as those with kidney transplant to better understand these patients' perspectives related to telemedicine.Study DesignQualitative Meta-AnalysisSetting & Study ParticipantsPre-dialysis chronic kidney disease and kidney transplant patients that used telemedicine.Selection Criteria for StudiesEnglish language studies published in the year 2000 and beyond that investigated patient perspectives in a qualitative manner. Works that were not qualitative or did not focus on provider-patient interactive modes of telemedicine were excluded.Data Extraction375 papers were pulled from PubMed, Embase, and Academic Science Premier. After filtering, 8 final papers were selected. These papers were critically appraised for quality and were used in the final analysis.Analytical ApproachWe used a grounded theory approach to develop a codebook to systematically review each of the selected papers through a qualitative meta-analysis of the included literature.ResultsTelemedicine was seen by patients to have notable strengths as well as weaknesses. These characteristics can be organized into four primary themes (autonomy, logistics, privacy/confidentiality, and trust). Within each primary theme, we identified subthemes. Universally, all papers included the subtheme "fewer trips to the healthcare facility" as a beneficial factor of telemedicine within the primary theme "logistics". A majority (6/8) of the papers included positive patient perspectives on the primary theme "autonomy" in terms of telemedicine promoting the subtheme of "engagement". Patients' views on telemedicine were mixed in regards to the primary themes of "privacy/confidentiality" and "trust" related to telemedicine.LimitationsLack of provider perspectives, non-English studies, and studies published before the year 2000. Papers published after the start of data extraction were also not included.ConclusionsTelemedicine should continue to be offered to patients with chronic kidney disease and kidney transplant patients to facilitate access. Additional research should focus on ways to decrease negative factors experienced by some patients such as difficulty using the technology. While the use of telemedicine has increased dramatically across disciplines, patient perspectives on telemedicine related to chronic kidney disease are not well understood. We systematically reviewed qualitative studies on patients with chronic kidney disease as well as those with kidney transplant to better understand these patients' perspectives related to telemedicine. Qualitative Meta-Analysis Pre-dialysis chronic kidney disease and kidney transplant patients that used telemedicine. English language studies published in the year 2000 and beyond that investigated patient perspectives in a qualitative manner. Works that were not qualitative or did not focus on provider-patient interactive modes of telemedicine were excluded. 375 papers were pulled from PubMed, Embase, and Academic Science Premier. After filtering, 8 final papers were selected. These papers were critically appraised for quality and were used in the final analysis. We used a grounded theory approach to develop a codebook to systematically review each of the selected papers through a qualitative meta-analysis of the included literature. Telemedicine was seen by patients to have notable strengths as well as weaknesses. These characteristics can be organized into four primary themes (autonomy, logistics, privacy/confidentiality, and trust). Within each primary theme, we identified subthemes. Universally, all papers included the subtheme "fewer trips to the healthcare facility" as a beneficial factor of telemedicine within the primary theme "logistics". A majority (6/8) of the papers included positive patient perspectives on the primary theme "autonomy" in terms of telemedicine promoting the subtheme of "engagement". Patients' views on telemedicine were mixed in regards to the primary themes of "privacy/confidentiality" and "trust" related to telemedicine. Lack of provider perspectives, non-English studies, and studies published before the year 2000. Papers published after the start of data extraction were also not included. Telemedicine should continue to be offered to patients with chronic kidney disease and kidney transplant patients to facilitate access. Additional research should focus on ways to decrease negative factors experienced by some patients such as difficulty using the technology.