Peer mentoring: a culturally sensitive approach to end-of-life planning for long-term dialysis patients.
BACKGROUND
This study is designed to explore the impact of peer mentoring on end-of-life decision making.


METHODS
A controlled randomized intervention study with 203 patients from 21 dialysis centers across Michigan explored the impact of peer mentors, dialysis patients trained to help other patients, on end-of-life planning.


RESULTS
Communicating information on advance directives (ADs) through peer mentoring significantly influenced the completion of ADs overall compared with distributing standard printed material or no specific designed intervention. However, the influence was most prominent among African Americans, not only increasing actual completion of ADs (P < 0.001) and comfort discussing ADs (P < 0.01), but also improving subjective well-being (P < 0.05) and anxiety (P < 0.05) during the study period. These effects of peer mentoring did not appear among white patients, although printed material on ADs decreased reported suicidal ideation (P < 0.05).


CONCLUSIONS
These results suggest the importance of addressing specific cultural factors in the process of AD education. Common practice assumes that printed materials are effective in educating patients about health care and decision making. However, peer mentoring, a relationship-centered person-to-person approach, may be more effective in some cultural groups because it partakes of oral, rather than written, traditions. Acknowledging cultural differences and tailoring our approach could be powerful in enhancing trust and participation and decreasing potential disparities in health care outcomes.
Perry
Erica
E
National Kidney Foundation of Michigan, Ann Arbor, MI 48108, USA. eperry@nkfm.org
Swartz
June
J
Brown
Stephanie
S
Smith
Dylan
D
Kelly
George
G
Swartz
Richard
R
D000328:Adult; D016223:Advance Directives; D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety; D001293:Attitude to Death; D003466:Cultural Characteristics; D003657:Decision Making; D005239:Fear; D005260:Female; D006436:Hemodialysis Units, Hospital; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D008297:Male; D008611:Mentors; D008824:Michigan; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods* / Q000458:organization & administration; D010379:Peer Group; D006435:Renal Dialysis / Q000523:psychology*; D012944:Social Support; D013664:Teaching Materials; D013727:Terminal Care / Q000523:psychology*; D044465:White People / Q000523:psychology