The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: A randomized trial

被引:205
作者
Manns, BJ
Taub, K
VanderStraeten, C
Jones, H
Mills, C
Visser, M
McLaughlin, K
机构
[1] Univ Calgary, Dept Med, Div Nephrol, Calgary, AB, Canada
[2] Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada
[3] Inst Hlth Econ, Edmonton, AB, Canada
关键词
chronic kidney disease; self-care dialysis; peritoneal dialysis; randomized controlled trial; education;
D O I
10.1111/j.1523-1755.2005.00594.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background. Compared with in-center hemodialysis, self-care dialysis (including home and self-care hemodialysis and peritoneal dialysis) is less resource intensive and associated with similar clinical outcomes. However, utilization of self-care dialysis has been very low. We performed a randomized controlled trial in predialysis patients with chronic kidney disease (CKD) (GFR < 30 mL/min) to determine the impact of a patient-centered educational intervention on patients' intention to initiate dialysis with self-care dialysis. Methods. Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were randomized to receive either (1) a two-phase patient-centered educational intervention (phase 1 included educational booklets and a 15-minute video on self-care dialysis; phase 2 included a 90-minute small group interactive educational session on self-care dialysis) in addition to their regular multidisciplinary care, or (2) ongoing standard care and education in the multidisciplinary predialysis clinic. The primary outcome was patients' intention to initiate dialysis with self-care dialysis, assessed by questionnaire. Results. Thirty-five patients were randomized to standard care; 34 completed the study. Thirty-five patients were randomized to the educational intervention; 30 completed phase 1 and 28 completed phase 2. By study end, significantly more patients in the intervention group (82.1%) intended to start dialysis with self-care dialysis compared with the standard care group (50%, P= 0.015). This difference persisted after controlling for the small baseline differences among patients in the two study groups (P= 0.004). Conclusion. A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.
引用
收藏
页码:1777 / 1783
页数:7
相关论文
共 30 条
[1]  
Agraharkar Mahendra, 2003, Adv Perit Dial, V19, P163
[2]  
Ahlmen J, 1993, Perit Dial Int, V13 Suppl 2, pS196
[3]   LIVE AND LEARN - PATIENT EDUCATION DELAYS THE NEED TO INITIATE RENAL REPLACEMENT THERAPY IN END-STAGE RENAL-DISEASE [J].
BINIK, YM ;
DEVINS, GM ;
BARRE, PE ;
GUTTMANN, RD ;
HOLLOMBY, DJ ;
MANDIN, H ;
PAUL, LC ;
HONS, RB ;
BURGESS, ED .
JOURNAL OF NERVOUS AND MENTAL DISEASE, 1993, 181 (06) :371-376
[4]  
BLOEMBERGEN WE, 1995, J AM SOC NEPHROL, V6, P177
[5]   Why don't physicians follow clinical practice guidelines? A framewouk for improvement [J].
Cabana, MD ;
Rand, CS ;
Powe, NR ;
Wu, AW ;
Wilson, MH ;
Abboud, PAC ;
Rubin, HR .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (15) :1458-1465
[6]  
*CAN I HLTH INF, 2002, DIAL REN TRANSPL 200, V1
[7]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[8]   Mortality risks of peritoneal dialysis and hemodialysis [J].
Collins, AJ ;
Hao, WL ;
Xia, H ;
Ebben, JP ;
Everson, SE ;
Constantini, EG ;
Ma, JZ .
AMERICAN JOURNAL OF KIDNEY DISEASES, 1999, 34 (06) :1065-1074
[9]  
DAVIS DA, 1995, JAMA-J AM MED ASSOC, V274, P700
[10]  
DOBBY SA, 1992, CANNT J FAL, P17