Self-management interventions for adults with chronic kidney disease: a scoping review

Abstract

ObjectiveTo systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD).SettingCommunity-based.ParticipantsAdults with CKD stages 1–5 (not requiring kidney replacement therapy).InterventionsSelf-management strategies for adults with CKD.Primary and secondary outcome measuresUsing a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-management interventions for adults with CKD stages 1–5 (not requiring kidney replacement therapy). Randomised controlled trials (RCTs), non-RCTs, qualitative and mixed method studies were included and study selection and data extraction were independently performed by two reviewers. Outcomes included behaviours, cognitions, physiological measures, symptoms, health status and healthcare.ResultsFifty studies (19 RCTs, 7 quasi-experimental, 5 observational, 13 pre-post intervention, 1 mixed method and 5 qualitative) reporting 45 interventions were included. The most common intervention topic was diet/nutrition and interventions were regularly delivered face to face. Interventions were administered by a variety of providers, with nursing professionals the most common health professional group. Cognitions (ie, changes in general CKD knowledge, perceived self-management and motivation) were the most frequently reported outcome domain that showed improvement. Less than 1% of the interventions were co-developed with patients and 20% were based on a theory or framework.ConclusionsThere was a wide range of self-management interventions with considerable variability in outcomes for adults with CKD. Major gaps in the literature include lack of patient engagement in the design of the interventions, with the majority of interventions not applying a behavioural change theory to inform their development. This work highlights the need to involve patients to co-developed and evaluate a self-management intervention based on sound theories and clinical evidence.

Overview of Self-Management Resources Used by Canadian Chronic Kidney Disease Clinics: A National Survey

“…The results of our survey of Canadian CKD clinics are consistent with our scoping review of self-management interventions for adults with CKD, 13 with nurses being the most common provider and the outpatient setting the most common location. 13 There were a few differences also noted.…”

“…The results of our survey of Canadian CKD clinics are consistent with our scoping review of self-management interventions for adults with CKD, 13 with nurses being the most common provider and the outpatient setting the most common location. 13 There were a few differences also noted. While self-management interventions commonly reported in the literature are related to topics of diet and nutrition and delivered face-to-face, 13 modality education and print were the most common topics and delivery format reported by the CKD clinics in our survey.…”

“… 13 There were a few differences also noted. While self-management interventions commonly reported in the literature are related to topics of diet and nutrition and delivered face-to-face, 13 modality education and print were the most common topics and delivery format reported by the CKD clinics in our survey. These differences in topic and delivery mode may be related to the structure and models of care provided by Canadian CKD clinics that include patients that predominantly have advanced CKD approaching the need for RRT.…”

Preferences for a self-management e-health tool for patients with chronic kidney disease: results of a patient-oriented consensus workshop

“…7 Five patient partners and 1 caregiver were engaged in the previous phases of this work, including a scoping review, a survey of chronic kidney disease clinics, analysis of behaviours of patients with chronic kidney disease and caregivers by means of the Theoretical Domains Framework and a qualitative study. 5,6,8,9 This has laid the foundation for the present study. Based on the qualitative study, 8 topic areas were identified -understanding chronic kidney disease, diet, medications, symptoms, finances, mental and physical health, travel and work/school -as well as features including mixed-content formats (e.g., visuals, text, user-generated content).…”

“…Research created a skeleton persona using quantitative and qualitative data from our prior work including demographic description (e.g., age, diagnosis, hobbies, life experiences), goals (e.g., lifestyle) and challenges (e.g., frustrations, concerns). 5,8 In consultation with our 6 patient partners, using an iterative process, we modified persona features, including names, goals, challenges, technical ability (computer literacy, Internet use/ availability) and health behaviour characteristics (health literacy, support networks, knowledge of health status, readiness for change). The revised personas were reviewed at an inperson research team meeting and were finalized through discussion and agreement.…”