Validity of a Standard Information Protocol Provided to End-Stage Renal Disease Patients and Its Effect on Treatment Selection

Abstract

Objective To evaluate the validity of a standard information package, comprising written and audiovisual aids, for end-stage renal disease (ESRD) patients in a pre-dialysis program. Study Design A multicenter study comprising patients entering a predialysis program. Three questionnaires were developed to gather data in this study: (1) a pre-information package questionnaire that evaluates the patient's initial knowledge of ESRD and the treatment options available (pre-informed patients); (2) a post-information package questionnaire that evaluates the patient's knowledge of ESRD and treatment options after being informed according to the protocol (post-informed patients); (3) a “start of the treatment” questionnaire that deals with the patient's choice of treatment at the time of starting dialysis, as well as the reasons leading to that choice. In all three questionnaires the patient's age, gender, level of creatinine clearance (Ccr), and hematocrit were recorded. Inclusion Criteria Any patient who was on a predialysis program in the participating centers. Results Three hundred and four patients were evaluated across 14 participating centers. Initial knowledge was assessed in 216 pre-informed patients (questionnaire 1). Patients were then guided through the information package. One hundred and fifty-eight patients answered the post-information package (questionnaire 2). During the course of the study, 174 patients (of the initial 304) started renal replacement therapy. Of these, 49.4% (86 patients) had received predialysis information according to our study protocol. All the patients who received the information throughout the trial improved their knowledge of ESRD and treatment options; this improvement was statistically significant. Conclusions The treatment options least well known at the start of the study were the peritoneal dialysis techniques. After receiving the information package, patients had an equal knowledge of all the different treatments, although hemodialysis was still the most familiar. This improvement in knowledge enabled patients who started a dialysis treatment to choose a therapy according to their own preferences. Their selections were as follows: 44% of the patients chose hemodialysis, 40% chose continuous ambulatory peritoneal dialysis, and 16% chose automated peritoneal dialysis. The standard information package, used as a patient education program, effectively resulted in patients having a significantly improved level of knowledge and understanding of ESRD and the different treatment options available.

Shared Decision Making and Patient Involvement in Choosing Home Therapies

“…This increased recognition of in-centre HD could be due to HD being the most prevalent form of dialysis therapy over the last few decades and is also the most visible treatment within the hospital setting. Increased familiarity of in-centre HD compared to PD has been observed (Gomez et al 1999) and can be exemplified in the following patient quote: 'I suppose the blood one is probably the proper one, I don't know' (Morton et al 2010). Therefore, environmental factors may be contributing to increased familiarity of in-centre HD, prior to any educational intervention, which in turn could lead to attribution of greater value to in-centre HD compared to home therapies.…”

Modality options for renal replacement therapy: The integrated care concept revisited

“…[47][48][49][50][51][52] Physicians interested in home dialysis should note that patients referred early and adequately educated about dialysis modalities seem more likely to choose home HD or PD. 30,31,40,[53][54][55] Nephrologist attitudes, opinions, educational deficits, and biases It is stated that a lack of training and experience of nephrologists and nurses and physician bias affect modality selection. 40,56 Surveyed nephrologists have ranked the following factors as leading causes for the decline in PD utilization (in descending order): aging patient cohort (with greater comorbidity), increased satellite HD units closer to patient' s home, concerns about technical failure of PD, decreased availability of PD capacity, and high rate of late referral for predialysis care.…”

Chronic kidney disease stressors influence choice of dialysis modality

“…Regardless of the mode of the educational programme delivered or the evaluative study design, patient awareness and knowledge of home-dialysis therapies are repeatedly associated with home-dialysis selection (Prichard 1996, Gomez et al 1999, Klang et al 1999, Stack 2002, Wuerth et al 2002, Agraharkar et al 2003, McLaughlin et al 2003, Goovaerts et al 2005, Manns et al 2005, Mehrotra et al 2005, Marron et al 2006, Pagels et al 2008, Hyphantis et al 2010. Why does education have such a strong effect on home-dialysis selection?…”