Implementing patient-reported experience measures in dialysis: organisational insights from nurse-led care settings

Context: The shift toward people-centred care underscores the need for tools capable of capturing patients’ experiences and translating them into actionable service improvements. Patient-Reported Experience Measures (PREMs) provide a means to assess healthcare services from the patients’ perspective, yet clear guidance for their implementation in clinical practice remains limited, particularly regarding administration methods. In dialysis care, these challenges are especially evident in limited-assistance centres, where medical assistance is entrusted to nurses and physicians are rarely present. It is therefore critical to address this gap by examining how PREMs can be embedded within dialysis pathways to support quality improvement. Methods: This study investigates how dialysis PREMs can support quality improvement and how their design, administration, and management should be implemented in practice. A multi-method and multi-country approach was adopted. Phase 1 consisted of a desk review of published literature and secondary sources to map the current state of PREMs in dialysis, including available questionnaires and administration strategies across countries. Phase 2 comprised an exploratory qualitative analysis of nurses’ perspectives and experiences with PREMs and their administration. This phase was conducted through approximately 30-minute individual semi-structured interviews with 15 nurses from four hospitals, two in Northern Italy and two in Switzerland, across their respective limited-assistance dialysis centres. A validation step was then carried out, in which the results of the interviews were returned to participants. Interviewees confirmed and reinforced the themes identified. Results: Phase 1 findings indicate that, despite broad recognition of the relevance of PREMs and the availability of multiple questionnaires, their systematic use in dialysis remains limited. Barriers include inadequate administration strategies, poor organisational integration, and persistent scepticism among professionals regarding the validity of these tools. Results from phase 2 showed strong convergence among nurses across sites. Participants agreed that PREMs should be administered during dialysis sessions, ideally at the start of the treatment. Paper-based formats were favoured, with nurse-assisted completion considered essential for older or frail patients. Digital tools were viewed as useful primarily for back-end data management. Nurses reported limited previous exposure to PREMs but acknowledge their potential to improve care. Perceived barriers included patients’ difficulties in understanding questionnaires and increased nurses’ workload, while facilitators involved short and plain language questionnaires, nurse support, and regular feedback loops directed to both patients and staff. Discussion: This study confirms a persistent implementation gap between the recognised value of PREMs in dialysis and their limited use in practice. Rather than conceptual resistance, practical and organisational constraints impede adoption, particularly in nurse-led limited-assistance centres, where operational burden is already high and physicians are seldom present. Across cases, respondents converged on key organisational features that would enable meaningful use of PREMs: clearly defined roles, appropriate timing, balanced use of paper and digital tools, and structured feedback mechanisms. Nurses emerged as central actors, serving as the main point of contact for patients, trusted communicators, and the professionals most likely to ensure PREMs are completed, especially for older or frail individuals. Their involvement is therefore essential both to facilitate PREMs administration and to mediate between patients and physicians. These insights inform future steps aimed at co-designing practical administration models and integrating PREMs sustainably into dialysis pathways, thereby supporting continuous quality improvement.