Early home-based group education to support informed decision-making among patients with end-stage renal disease: a multi-centre randomized controlled trial.
The aim was to test the effectiveness of early home-based group education on knowledge and communication about renal replacement therapy (RRT).



We conducted a randomized controlled trial using a cross-over design among 80 end-stage renal disease (ESRD) patients. Between T0 and T1 (weeks 1-4) Group 1 received the intervention and Group 2 received standard care. Between T1 and T2 (weeks 5-8) Group 1 received standard care and Group 2 received the intervention. The intervention was a group education session on RRT options held in the patient's home given by social workers. Patients invited members from their social network to attend. Self-report questionnaires were used at T0, T1 and T2 to measure patients' knowledge and communication, and concepts from the Theory of Planned Behaviour such as attitude. Comparable questionnaires were completed pre-post intervention by 229 attendees. Primary RRT was registered up to 2 years post-intervention. Multilevel linear modelling was used to analyse patient data and paired t-tests for attendee data.



Statistically significant increases in the primary targets knowledge and communication were found among patients and attendees after receiving the intervention. The intervention also had a significant effect in increasing positive attitude toward living donation and haemodialysis. Of the 80 participants, 49 underwent RRT during follow-up. Of these, 34 underwent a living donor kidney transplant, of which 22 were pre-emptive.



Early home-based group education supports informed decision-making regarding primary RRT for ESRD patients and their social networks and may remove barriers to pre-emptive transplantation.
Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Emma K
EK
Massey
Department of Nephrology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands.
Peter J H Smak
PJ
Gregoor
Department of Nephrology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Robert W
RW
Nette
Department of Nephrology, Maasstadziekenhuis, Rotterdam, The Netherlands.
Marinus A
MA
van den Dorpel
Department of Nephrology, Maasstadziekenhuis, Rotterdam, The Netherlands.
Anthony
A
van Kooij
Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Robert
R
Zietse
Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Willij C
WC
Zuidema
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
Reinier
R
Timman
Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands.
Jan J
JJ
Busschbach
Department of Internal Medicine, Section Nephrology & Transplantation, Erasmus Medical Center, Rotterdam, The Netherlands.
Willem
W
Weimar
D003142:Communication; D018592:Cross-Over Studies; D003657:Decision Making; D018479:Early Intervention, Educational; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D006435:Renal Dialysis / Q000523:psychology*; D017582:Renal Replacement Therapy / Q000379:methods* / Q000523:psychology; D011795:Surveys and Questionnaires
kidney transplantation; living donors; patient education; renal dialysis; renal replacement therapy