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Background Patients undergoing hemodialysis have a high mortality rate and yet underutilize palliative care and hospice resources. The Shared Decision Making-Renal Supportive Care (SDM-RSC) intervention focused on goals of care conversations between patients and family members with the nephrologist and social worker. The intervention targeted deficiencies in communication, estimating prognosis, and transition planning for seriously ill dialysis patients. The intervention showed capacity to increase substantially completion of advance care directives. The HIGHway Project, adapted from the previous SDM-RSC, scale up training social workers or nurses in dialysis center in advance care planning (ACP), and then support them for a subsequent 9-month action period, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. Methods We will train between 50–60 dialysis teams, led by social workers or nurses, to engage in ACP conversations with patients at their dialysis center regarding their preferences for end-of-life care. This implementation project uses the Knowledge to Action (KTA) Framework within the Consolidated Framework for Implementation Research (CFIR) to increase adoption and sustainability in the participating dialysis centers. This includes a curriculum about how to hold ACP conversation and coaching with monthly teleconferences through case discussion and mentoring. An application software will guide on the process and provide resources for holding ACP conversations. Our project will focus on implementation outcomes. Success will be determined by adoption and effective use of the ACP approach. Patient and provider outcomes will be measured by the number of ACP conversations held and documented; the quality and fidelity of ACP conversations to the HIGHway process as taught during education sessions; impact on knowledge and skills; content, relevance, and significance of ACP intervention for patients, and Supportive Kidney Care (SKC) App usage. Currently HIGHway is in the recruitment stage. Discussion Effective changes to advance care planning processes in dialysis centers can lead to institutional policy and protocol changes, providing a model for patients receiving dialysis treatment in the US. The result will be a widespread improvement in advance care planning, thereby remedying one of the current barriers to patient-centered, goal-concordant care for dialysis patients. Trial registration The George Washington University Protocol Record NCR213481, Honoring Individual Goals and Hopes: Implementing Advance Care Planning for Persons with Kidney Disease on Dialysis, is registered in ClinicalTrials.gov Identifier: NCT05324878 on April 11th, 2022.

mHealth products. Therefore, this study aimed to characterise real-world experiences of mHealth products for patients with diabetes, one of the largest populations of mHealth users. Publicly available posts from patients with diabetes (both types) and/or caregivers about continuous blood glucose monitoring were extracted from the Diabetes.co.uk forum, from 2016 to 2019, and subset to those containing names of select diabetes mHealth products. From these, a random sample of 80 users (153 posts) were qualitatively analysed using thematic analysis. Of 80 users, 73 had posts relevant to the study objectives, and 7 users were excluded as they did not provide an experience or perception of mHealth. Most common themes were satisfaction (32 users, 44% of users), accuracy (25 users, 34%) and cost (22 users, 30%). Of users mentioning satisfaction, 84% were happy with the product. However, where users discussed accuracy, 56% did not believe products to be accurate, and 32% discussed inconsistencies between outputs of different devices. Some users however, said accuracy did not matter as the value of mHealth is in tracking trends (32%). Cost was important for continued use of mHealth devices, and discussions regarding cost often related to NHS and insurance provision of mHealth products (11 users, 50%). mHealth is changing diabetes management, and whilst many users express positive attitudes there are key challenges for mHealth to overcome if its growth is to continue. This study can help researchers understand use-behaviours of mHealth products, in addition to areas for improvement to maximise benefit to patients with diabetes.

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Objectives: Extrapulmonary impacts of chronic obstructive pulmonary disease (COPD) often include sleep disturbance, poor sleep quality, and daytime sleepiness resulting in detrimental impact on patients' overall health-related quality of life (HRQoL). This study evaluated the impact of sleep disturbance on HRQoL in patients with COPD. Methods: Literature searches were performed in biomedical databases until March 2019. Specific search terms identified observational studies assessing HRQoL in COPD that included sleep as a patient-reported outcome (PRO) endpoint. Only full text articles published in English were included. Results: Out of total 1247 abstracts identified for initial screening, 177 were selected for full text review. Based on the inclusion criteria, PRO-related information from 36 studies are analyzed. Sleep disturbances and poor sleep quality was on average prevalent in more than onethird, ranging from 27%-100% of COPD patients.