Table 1 Intervention similarities and differences between renal programs

Setting

•All three renal programs will implement the intervention in in-centre hemodialysis units only, excluding home hemodialysis and peritoneal dialysis units

•The three geographically based renal programs have similar models of multi-disciplinary care

Disease-specific PROM Use

•AKC-N and ORN will use the ESAS-r: Renal

•ACK-S will use the IPOS-Renal

Generic PROM Use

All renal programs will use the EQ-5D-5 L

Frequency of PROMs

All renal programs will administer the PROM(s) every 2 months

Mode of PROMs Administration

•ORN: clinicians will administer PROMs by paper and store in patients’ charts

•AKC-N: clinicians will administer PROMs by paper and then enter PROMs results into their EMR

•AKC-S: clinicians will administer PROMs by iPad, directly entering results into their EMR

PROMs Report Cards

•AKC-N and AKC-S will generate a PROMs report card with a symbol scheme categorizing symptoms/problems into ‘no symptom/problem present’, ‘mild symptom/problem’ and ‘moderate-severe symptom/problem’

•ORN will simply use the completed PROM(s) for review and discussion

Treatment Aids

Each renal program developed their own symptom guidelines for clinicians and patient information handouts

Clinical Workflow

All renal programs will deliver the EMPATHY intervention in 3 phases:

1. Screening: PROM(s) are administered every 2 months

2. Assessment: Clinician reviews PROM(s) results with the patient and discuss where management is needed

3. Management: Clinician uses the treatment aids to manage symptoms, as applicable

Outcome Measures Survey Frequency

All renal programs will collect the outcome measures through a survey collected at baseline, 6 months, and 12 months

Outcome Measures Survey Mode of Administration

•AKC-N and AKC-S will administer the outcome measures survey by iPad, with a paper back-up (e.g., where wifi access not available)

•ORN will administer the outcome measures survey by paper

Clinician Training

•Each renal program will deliver their own training of the intervention to clinicians as the intervention is slightly different across the renal programs

•The overall delivery of education between the three programs will be very similar, using a ‘train-the-trainer’ approach, whereby clinical leaders will first be trained at each site and these leaders will then train relevant clinicians using their usual mechanisms of disseminating new clinical information/policy and procedures

•Within each renal program, each unit will name a staff member to act as the ‘EMPATHY site lead’ to champion the trial in the unit and act as a liaison between the unit and the research team