A Pilot Randomized Trial of Financial Incentives or Coaching to Lower Serum Phosphorus in Dialysis Patients

Strategies to improve dietary, fluid, dialysis or medication adherence in patients with end stage kidney disease on dialysis: A systematic review and meta-analysis of randomized intervention trials

“…The dominant category was assigned by consensus, with guidance when necessary from the senior psychologist among the authors. Eleven studies evaluated educational or cognitive interventions, four had behavioural or counselling interventions [6, 12, 27, 45], four had psychological or affective interventions [33, 39, 48, 49] and fourteen studies had elements of different categories in the trialled intervention (refer to Table 1).…”

“…The lack of standardized methods to measure adherence in these domains, contributes to the reported variations in the rate of non-adherence, and the difficulty of precisely estimating the effectiveness of interventions to improve adherence [3, 5]. Methods of measuring adherence vary across studies and include indirect measures, such as self-reported adherence [6, 7]; direct measures such as pill counts or electronic medication event monitoring system (MEMS) [8], and attendance in dialysis sessions [9]; as well as surrogate measures such as inter-dialytic weight gain [10, 11] or biochemical parameters, which include phosphate and potassium levels [12, 13].…”

A Long Road to Travel: Adherence to Dietary Recommendations and Adequate Dietary Phosphorus Control

“…However, in conjunction, selfreported binder nonadherence was the strongest determinant of poor serum phosphorus control. Short-term symbolic rewards, such as financial incentives 23 and strategies to improve self-motivation, 24 are examples to support adherence to therapy. Patient actions are, in part, influenced by our collective efforts to inform them about the harmful effects of excessive dietary phosphorus intake on health outcomes.…”

Breaking the adherence barriers: Strategies to improve treatment adherence in dialysis patients

“…Diet diary/ checklist 23,[38][39][40] End Stage Renal Disease Adherence Questionnaire (ESRD-AQ) 41 Medication Adherence Report Scale (MARS) 42 Morisky-Green 4-item medication scale 23 Morisky Medication Adherence Scale (MMAS) 43 Patient interviews 38,44,45 Renal Adherence Behavior Questionnaire (RABQ) 42 Researcher designed/modified questionnaires 42,[46][47][48][49] Can be affected by factors other than adherence like biological variability or medications used to control these measures Adjusting for confounding variables may be difficult Phosphate 31,37,38,[42][43][44][45][46][48][49][50][51][52][53][54][55][56][57][58][59][60][61] Calcium x phosphate product 44,48,[50][51][52][53]57 PTH 31,…”

“…Information deficits concerning disease or treatment‐ specific knowledge are common in dialysis patients, and their correction by educational strategies may modify the patient's perspectives about the need to adhere to treatment. Educational/cognitive interventions were trialed either as the sole strategy (Aghakhani et al, 54 Ashurst Ide et al, 50 Baraz et al, 55 Chen et al, 38 de Araujo et al, 51 Ford et al, 44 Karavetian et al, 48 Lou et al, 56 Sehgal et al, 24 Shi et al, 52 Skoutakis et al, 79 Vrdoljac et al, 61 Wong et al, 36 Yokum et al 53 ) or in combination with counselling/ behavioral strategies (Brantley et al, 47 Cukor et al, 63 Griva et al, 37,42 Hare et al, 71 Hou et al, 64 Karavetian et al, 49 Kauric‐Klein et al, 23 Molaison et al, 66 Morey et al, 57 Reese et al, 43 Sevick et al, 40 Sharp et al, 68 Sullivan et al, 45 Tsay et al, 69 Welch et al, 39 Zhianfar et al 41 ). The primary interventions were delivered mostly through individual format, but some studies which used a combination of cognitive and behavioral strategies used a group format 41,42,68,71 …”