Nephrologists' perception of the French national guidelines in nephrology

Abstract

In France, the "Haute Autorité de Santé" (HAS), an independent public scientific authority, regularly publishes guidelines targeted to healthcare professionals. As their implementation is left to the healthcare professionals' discretion, their perception could influence their application. The aim of this study was to assess the nephrologists' perception of the HAS guidelines on nephrology in general and on the access to the kidney transplant waiting list. We used a mixed methods approach with an exploratory design combining analysis of qualitative and quantitative data. Nephrologists practicing in France were included. We collected qualitative data in face-to-face semi-structured interviews and identified the main themes through an inductive thematic analysis. We collected quantitative data through an online questionnaire designed based on the qualitative findings. The analysis of interviews with 45 nephrologists (22 women) identified three main themes: (i) nephrologists' knowledge and sources of information on HAS guidelines in nephrology; (ii) their perception of these guidelines and relevance to medical practice; (iii) age limit to access the kidney transplant waiting list in the 2015 guidelines. The quantitative analysis included 126 nephrologists (47.6% women), among whom 84.1% had already heard about these guidelines. Respectively, 85.8% and 80.2% found the guidelines "clear" and "complete". Overall, the quantitative data confirmed the qualitative findings. This study shows how nephrologists perceive the HAS guidelines. This will inform discussions on how to make these guidelines more accessible to nephrologists. New studies could be carried out to better quantify and qualify the effect of these guidelines.

Keywords: Guidelines; Mixed methods; Nephrology; Perception.