Study with pre-dialysis and dialysis patients who were diagnosed with Chronic Kidney Disease (CKD) and Anaemia and were taking iron supplementation to treat Anaemia. We recruited, moderated and submitted transcripts and interview audio-recordings using local teams of recruiters and moderators in each country. 

Methodology

The study aimed to pinpoint symptoms of iron, anaemia and CKD separately and to look at how each of these symptoms affected the individual’s life. The discussion focused around symptoms and iron supplements side effects. Interviews lasted 45 minutes each and were conducted over the phone.

Patients were carefully selected through an extensive screener document, which incorporated – beside the actual screening questions – a clinical form on medications and blood test values and a socio-demographic form.

After the interview each patient had to complete a 4 page questionnaire which investigated further patients’ quality of life and general well-being (physical, social, emotional and functional well-being) as well as any other concerns that the patient may have had.

Markets
UK – 10 pre-dialysis and 10 dialysis patients (20 patients in total)
Germany – 5 pre-dialysis and 5 dialysis patients (10 patients in total)
Spain– 5 pre-dialysis and 5 dialysis patients (10 patients in total)

 

Challenges

Recruitment
The main challenge was, of course, to reach the required quota in all markets and recruit patients who fully met all screening criteria. Some of those criteria – like the administration of iron supplementation for a minimum of 4 consecutive months as a mandatory inclusion criterion – were particularly difficult to fulfil, as very few patients take iron supplements for that long.  Other criteria  – such as transplant as an exclusion criterion – were added during the fieldwork and reduced incidence considerably. In addition to this, interviews with dialysis patients were harder to schedule as they were of course not available on dialysis days. The recruitment was harder in the UK where a higher number of patients were required.

We overcame those challenges by using different recruitment approaches and lateral thinking and managed to complete the quota in all markets and within the requested timeline in Germany and Spain. The UK quota took a bit longer to complete. The majority of patients were recruited from our panel, while others were obtained through physicians’ referral or introduced to us through ‘snowballing’ by other patients who had already completed their interviews.

Moderation
A major challenge during the fieldwork was that some of patients were not able to distinguish between what was causing a particular symptom, whether iron, anaemia or CKD.

They sometimes suffered from other co-morbidities as well (CKD itself can be a result of a pre-existent condition) and took several medications every day. These complex patients profiles made it very difficult at times for the moderators to understand what medications and/or conditions were causing particular symptoms.

Another challenge was to obtain the completed post-interview questionnaires back from the patients. Some of them were elderly and very ill and did not have access to computer, internet and scanner. In most cases questionnaire were sent and returned by mail rather than fax or email. Sometimes they were not completed correctly or in their entirety and had to be sent twice.

Finally, some of the clinical form questions, like the latest Haemoglobin levels, were very hard to obtain as patients – especially those not on dialysis yet -  did not remember them and had to check with their surgeries or hospitals.

Conclusion
It was overall a challenging project because of the difficult target – patients in poor health conditions in most cases – as well as of the stringent screening criteria and the amount of details and information required from such a target. We managed to overcome most problems, complete the quota and deliver robust data to the client.