title: Patient Education and Peritoneal Dialysis Modality Selection: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Educational interventions are increasingly used to promote peritoneal dialysis (PD), the most common form of home therapy for end-stage renal disease. A systematic review of the evidence in support of dialysis modality education is needed to inform the design of patient-targeted interventions to increase selection of PD. We performed a systematic review and meta-analysis to characterize the relationship between patient-targeted educational interventions and choosing and receiving PD.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Published original studies and abstracts.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL and EBMR. We included controlled observational studies and randomized trials of educational interventions designed to increase PD selection.
  
  
  METHODS
  Predialysis educational interventions.
  
  
  RESULTS
  The primary outcome was choosing PD, defined as intention to use PD regardless of whether PD was ever used. The secondary outcome, receiving PD, was defined as an individual receiving PD as his or her treatment.
  
  
  RESULTS
  Of 3,540 citations, 15 studies met our inclusion criteria, including 1 randomized trial. In the single randomized trial (N=70), receipt of an educational intervention was associated with a more than 4-fold increase in the odds of choosing PD (OR, 4.60; 95% CI, 1.19-17.74). Based on results from 4 observational studies (N=7,653), patient-targeted educational interventions were associated with a 2-fold increase in the odds of choosing PD (pooled OR, 2.15; 95% CI, 1.07-4.32; I(2)=76.7%). Based on results from 9 observational studies (N=8,229), patient-targeted educational intervention was associated with a 3-fold increase in the odds of receiving PD as the initial treatment modality (OR, 3.50; 95% CI, 2.82-4.35; I(2)=24.9%).
  
  
  CONCLUSIONS
  Most studies were observational studies, which can establish an association between education and choosing PD or receiving PD, but does not establish causality.
  
  
  CONCLUSIONS
  This systematic review demonstrates a strong association between patient-targeted education interventions and the subsequent choice and receipt of PD.
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada. Electronic address: djadevoe@ucalgary.ca.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Devoe
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Ben
authors.initials: B
authors.lastname: Wong
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: James
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.affiliation: Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Lianne
authors.initials: L
authors.lastname: Barnieh
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Pauly
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
authors.affiliation: Saskatoon Health Region, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Joanne
authors.initials: J
authors.lastname: Kappel
authors.affiliation: Department of Medicine, Community Health Sciences, University of Calgary, Calgary, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010353:Patient Education as Topic; D010530:Peritoneal Dialysis
keywords: Peritoneal dialysis (PD); choosing PD; dialysis modality; end-stage renal disease (ESRD); medical decision-making; modality selection; patient choice; patient-centered care; patient-targeted educational intervention; renal replacement therapy (RRT); systematic review