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


CONCLUSIONS
A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.
Manns
Braden J
BJ
Division of Nephrology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada. Braden.Manns@calgaryhealthregion.ca
Taub
Ken
K
Vanderstraeten
Carmen
C
Jones
Heather
H
Mills
Cynthia
C
Visser
Marilyn
M
McLaughlin
Kevin
K
D000368:Aged; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018802:Patient-Centered Care; D010530:Peritoneal Dialysis; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000628:therapy*; D012648:Self Care