Numeracy Skills in CKD

Abstract

Background and objectives: Healthcare providers communicate the risks and benefits of treatments using frequencies, percentages, or proportions. However, many patients lack the numerical skills needed to interpret this information accurately to make informed choices.Design, setting, participants, and measurements: We assessed numeracy, the capacity to use and comprehend numbers, in a prospective cohort study of 187 patients with stage 4 to 5 chronic kidney disease or ESRD. Patients completed a three-item numeracy test and were assessed for global mental status, cognitive function, type of hemodialysis access, and kidney transplant use. We examined the association of numeracy with healthcare use and other cognitive and sociodemographic variables.Results: Over 50% of patients answered one or fewer numeracy questions correctly. Although African Americans (P ‫؍‬ 0.0001), women (P ‫؍‬ 0.05), and the unemployed (P ‫؍‬ 0.0004) demonstrated lower numeracy skills, numeracy deficits were prevalent in every subgroup. In analyses adjusted for demographics and length of follow-up, higher numeracy was significantly associated with receipt of a transplant or active waiting list status. Numeracy was not associated with dialysis modality or hemodialysis vascular access.Conclusion: Similar to prior findings in the general population, these findings indicate that poor numeracy skills are very common in patients with advanced chronic kidney disease and end-stage renal disease. Additional research is needed to further explore whether poor numeracy is a barrier to receipt of a kidney transplant. Clinicians caring for patients with kidney disease should consider using tools to enhance communication and overcome limited numeracy skills.

Know the risk, take the win: How executive functions and probability processing influence advantageous decision making under risk conditions

“…They show limited understanding of risks and benefits associated with a specific medical treatment (Weinfurt et al, 2003), have less insight into the benefits of cancer screening (Schwartz, Woloshin, Black, & Welch, 1997), have less access to treatment options, such as kidney transplantations (Abdel-Kader et al, 2010), show lower abilities in self-management of chronic disease (Cavanaugh et al, 2008), and are more strongly influenced by emotional framing (Peters et al, 2006;Reyna, Nelson, Han, & Dieckmann, 2009;Zamarian, Benke, Buchler, Wenter, & Delazer, 2010). Thus, previous studies suggest that low numerical abilities may significantly influence decision making in a real-world context.…”

Cognitive Impairment in Chronic Kidney Disease-Prevalence, Mechanisms and Consequences

“…Interestingly, patients with early stages of CKD already show cognitive impairment [20]. Depending on CKD stage, CKD is frequently associated with prevalence of cognitive impairment in different domains including executive function, information processing speed, memory and language, which range from 17% to 87% [7,[9][10][11][12][13][14][15].…”

“…Regarding consequences of CKD, most studies concentrate on cardiovascular morbidity and mortality [6], while cognitive function, which is an important determinant of adherence to CKD therapy, is often overlooked [7]. Cognitive impairment in CKD is getting an increasingly relevant topic for healthcare systems, since CKD prevalence worldwide is estimated to be about 12% [8] and cognitive impairment to affect 17% to 87% of CKD patients, depending on CKD severity [7,[9][10][11][12][13][14][15].…”

Conveying Uncertainty in Prognosis to Patients with ESRD

“…In general, patients' and physicians' interpretation of statistical information often differs enough that both parties leave the consultation with completely different understandings of what transpired [7,35,44,49,50,51]. Reliance on statistics is even more tenuous in nephrology, where CKD patients often have poor health numeracy skills [52]. Resources to aid in improving communication with our ESRD patients are listed (table 1) and the future development and validation of decision aids for this purpose would be helpful.…”