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Salas-Gama K, Díaz-Gómez JM, Bolíbar Ribas I. Appropriateness of the dialysis modality selection process: A cross-sectional study. Medicine (Baltimore) 2022; 101:e31041. [PMID: 36281100 PMCID: PMC9592345 DOI: 10.1097/md.0000000000031041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Studies that specifically quantify the appropriateness of the process of dialysis modality selection are lacking. Peritoneal dialysis (PD) offers clinical and social advantages over hemodialysis (HD), but may be underused. We aimed to determine the appropriateness of the process of dialysis modality selection and quantify the percentage of patients who could potentially have been PD candidates. We performed a cross-sectional study that included adult patients from a hospital Nephrology Department in Barcelona who started dialysis between 2014 and 2015. We assessed the appropriateness of dialysis modalities selection by defining 3 sequential domains based on 3 critical steps in choosing a dialysis modality: eligibility for either treatment, information about modalities, and shared decision-making. We obtained data using medical records and a patient questionnaire. The dialysis modality selection process was considered appropriate when patients had no contraindications for the selected option, received complete information about both modalities, and voluntarily chose the selected option. A total of 141 patients were included in this study. The median age was 72 years (interquartile range 63-82 years), and 65% of the patients were men. The dialysis modality selection process was potentially inappropriate in 22% of the participants because of problems related to information about dialysis modalities (15%) or shared decision-making (7%). Appropriate PD use can potentially increase from 17% to 38%. Patient age and lack of information regarding dialysis options were independently associated with the potential degree of inappropriate dialysis modality selection. Our findings indicate areas for improvement in the selection of dialysis modalities. With better education and shared decision-making, the number of patients with PD could potentially double. The analysis of appropriateness is a helpful approach for studying renal replacement treatment patterns and identifying strategies to optimize their use.
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Affiliation(s)
- Karla Salas-Gama
- Quality, Process and Innovation Direction, Valld’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Health Services Research Group, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- PhD candidate at the Methodology of Biomedical Research and Public Health program, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Barcelona, Spain
- *Correspondence: Karla Salas-Gama, Quality, Process and Innovation Direction, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain ()
| | - Juan-Manuel Díaz-Gómez
- Nephrology Department, Fundación Puigvert, IIB Sant Pau, Barcelona, Spain
- Medicine Department, Universitat de Vic (UVic-UCC), Vic, Spain
| | - Ignasi Bolíbar Ribas
- Consortium for Biomedical Research in Epidemiology and Public Health-CIBERESP, Barcelona, Spain
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Rodrigues LAS, Almeida FAD, Rodrigues CIS. Translation, cross-cultural adaptation and validation of the EPOCH-RRT questionnaire "Empowering Patients On Choices For Renal Replacement Therapy" for the Brazilian context. J Bras Nefrol 2022; 45:67-76. [PMID: 35789243 PMCID: PMC10139720 DOI: 10.1590/2175-8239-jbn-2021-0224en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a global public health problem. In Brazil, the incidence and prevalence rates of dialysis CKD progressively increase, but the transition process is a challenge for patients and caregivers in coping with the disease. Dialysis urgency, lack of planned access or prior knowledge of treatment is a reality for most. Guidelines recommend that treatment options should include the conscious preference of a fully informed patient. However, pre-dialysis educational information is an exception, leading to a large number of unplanned initial dialysis. The original study "Empowering Patients on Choices for Renal Replacement Therapy" (EPOCH-RRT) aimed to identify patient priorities and gaps in shared decision-making about dialysis, using structured interviews with questions about demographics, clinical history and patients' perception of their health. The goal of this study was to carry out the translation, cross-cultural adaptation and validation of the questionnaires used in the EPOCH-RRT Study for the Brazilian context. METHOD This is a methodological study that consisted of the initial translation, synthesis of the translations, back translation, review by a committee of experts, pre-test and evaluation of the psychometric properties of the instrument. All ethical precepts were followed. RESULTS The questionnaires were translated, adapted and validated for the Brazilian context. Additionally, it was applied to 84 chronic renal patients on hemodialysis, peritoneal dialysis and outpatients. DISCUSSION There is a lack of an educational-therapeutic approach aimed at patients with CKD, and the EPOCH-RRT questionnaire can be a tool for Brazilian dialysis services to change this paradigm.
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Affiliation(s)
- Luciana Adorno Sattin Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Programa de Estudos Pós-graduados em Educação nas Profissões de Saúde, Sorocaba, SP, Brasil
| | - Fernando Antonio de Almeida
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Programa de Estudos Pós-graduados em Educação nas Profissões de Saúde, Sorocaba, SP, Brasil
| | - Cibele Isaac Saad Rodrigues
- Pontifícia Universidade Católica de São Paulo, Faculdade de Ciências Médicas e da Saúde, Programa de Estudos Pós-graduados em Educação nas Profissões de Saúde, Sorocaba, SP, Brasil
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Rodrigues LAS, Almeida FAD, Rodrigues CIS. Tradução, adaptação transcultural e validação do questionário EPOCH-RRT “Empowering Patients On Choices For Renal Replacement Therapy” para o contexto brasileiro. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0224pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial. No Brasil, as taxas de incidência e prevalência da DRC dialítica aumentam progressivamente, mas o processo de transição apresenta-se como desafio para pacientes e cuidadores no enfrentamento da doença. Urgência dialítica, ausência de acesso planejado ou conhecimento prévio do tratamento é uma realidade para a maioria. Diretrizes recomendam que opções de tratamento devam incluir a preferência consciente de um paciente totalmente informado. No entanto, informação educacional pré-diálise é exceção, acarretando grande número de diálises iniciais não planejadas. O estudo original “Empowering Patients on Choices for Renal Replacement Therapy” (EPOCH-RRT) teve por objetivo identificar as prioridades do paciente e as lacunas na tomada de decisões compartilhadas sobre a diálise, utilizando entrevistas estruturadas, com questões sobre dados demográficos, história clínica e percepção dos pacientes sobre sua saúde. O objetivo desta pesquisa foi realizar a tradução, adaptação transcultural e validação dos questionários utilizados no Estudo EPOCH-RRT para o contexto brasileiro. Método: Trata-se de estudo metodológico que consistiu na tradução inicial, síntese das traduções, retro tradução, revisão por um comitê de especialistas, pré-teste e avaliação das propriedades psicométricas do instrumento. Todos os preceitos éticos foram seguidos. Resultados: Os questionários foram traduzidos, adaptados e validados para o contexto brasileiro. Adicionalmente, foi aplicado em 84 pacientes renais crônicos em hemodiálise, diálise peritoneal e ambulatoriais. Discussão: Há carência de enfoque educativo-terapêutico dirigido aos pacientes com DRC, e o questionário EPOCH-RRT pode ser uma ferramenta para serviços de diálise brasileiros mudarem esse paradigma.
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de Jong RW, Jager KJ, Vanholder RC, Couchoud C, Murphy M, Rahmel A, Massy ZA, Stel VS. Results of the European EDITH nephrologist survey on factors influencing treatment modality choice for end-stage kidney disease. Nephrol Dial Transplant 2021; 37:126-138. [PMID: 33486525 PMCID: PMC8719583 DOI: 10.1093/ndt/gfaa342] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Access to forms of dialysis, kidney transplantation (Tx) and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD) varies across European countries. Attitudes of nephrologists, information provision and decision-making may influence this access and nephrologists may experience several barriers when providing treatments for ESKD. METHODS We surveyed European nephrologists and kidney transplant surgeons treating adults with ESKD about factors influencing modality choice. Descriptive statistics were used to compare the opinions of professionals from European countries with low-, middle- and high-gross domestic product purchasing power parity (GDP PPP). RESULTS In total, 681 professionals from 33 European countries participated. Respondents from all GDP categories indicated that ∼10% of patients received no information before the start of renal replacement therapy (RRT) (P = 0.106). Early information provision and more involvement of patients in decision-making were more frequently reported in middle- and high-GDP countries (P < 0.05). Professionals' attitudes towards several treatments became more positive with increasing GDP (P < 0.05). Uptake of in-centre haemodialysis was sufficient to 73% of respondents, but many wanted increased uptake of home dialysis, Tx and CCM. Respondents experienced different barriers according to availability of specific treatments in their centre. The occurrence of barriers (financial, staff shortage, lack of space/supplies and patient related) decreased with increasing GDP (P < 0.05). CONCLUSIONS Differences in factors influencing modality choice when providing RRT or CCM to adults with ESKD were found among low-, middle- and high-GDP countries in Europe. Therefore a unique pan-European policy to improve access to treatments may be inefficient. Different policies for clusters of countries could be more useful.
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Affiliation(s)
- Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
| | - Raymond C Vanholder
- Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent
University Hospital, Ghent, Belgium
- European Kidney Health Alliance (EKHA), Brussels, Belgium
| | - Cécile Couchoud
- REIN Registry, Agence de la Biomédecine, Saint-Denis La
Plaine, France
| | - Mark Murphy
- The Irish Kidney Association CLG, Dublin, Ireland
| | - Axel Rahmel
- Deutsche Stiftung Organtransplantation, Frankfurt am Main,
Germany
| | - Ziad A Massy
- INSERM U1018, Équipe 5, Centre de Recherche en Epidémiologie et Santé des
Populations (CESP), Université Paris Saclay et Université Versailles Saint Quentin en
Yvelines (UVSQ), Villejuif, France
- Service de Néphrologie et Dialyse, Assistance Publique—Hopitaux de Paris
(APHP), Hôpital Universitaire Ambroise Paré, Boulogne-Billancourt,
France
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public
Health Research Institute, Amsterdam UMC, University of Amsterdam,
Amsterdam, The Netherlands
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Guía de unidades de hemodiálisis 2020. Nefrologia 2021. [DOI: 10.1016/j.nefro.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Buades JM, Craver L, Del Pino MD, Prieto-Velasco M, Ruiz JC, Salgueira M, de Sequera P, Vega N. Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? J Clin Med 2021; 10:2943. [PMID: 34209083 PMCID: PMC8268456 DOI: 10.3390/jcm10132943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease.
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Affiliation(s)
- Juan M. Buades
- Department of Nephrology, Hospital Universitario Son Llàtzer, Balearic Islands, 07198 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Lourdes Craver
- Department of Nephrology, Hospital Universitario Arnau de Vilanova, 25198 Lleida, Spain;
| | - Maria Dolores Del Pino
- Department of Nephrology, Complejo Hospitalario Torrecárdenas de Almería, 04009 Almería, Spain;
| | - Mario Prieto-Velasco
- Department of Nephrology, Complejo Asistencial Universitario de Leon, 24001 León, Spain;
| | - Juan C. Ruiz
- Department of Nephrology, Valdecilla Hospital, University of Cantabria, 39008 Santander, Spain;
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain
| | - Mercedes Salgueira
- Department of Nephrology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
- Biomedical Engineering Group, Medicine Department, University of Seville, 41092 Seville, Spain
- Center for Biomedical Research Network in Bioengineering Biomaterials and Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Patricia de Sequera
- Department of Nephrology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
- Medicine Department, Universidad Complutense de Madrid, 28031 Madrid, Spain
| | - Nicanor Vega
- Department of Nephrology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain;
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Prieto-Velasco M, Del Pino Y Pino MD, Buades Fuster JM, Craver Hospital L, Pons Prades R, Ruiz San Millán JC, Salgueira Lazo M, de Sequera Ortiz P, Vega Díaz N. Advanced Chronic Kidney Disease Units in Spain: a national survey on standards of structure, resources, results and patient safety. Nefrologia 2020; 40:608-622. [PMID: 33032839 DOI: 10.1016/j.nefro.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Recently, the Advanced Chronic Kidney Disease Units (UERCA, in Spanish) have been developed in Spain to offer a better quality of life to patients with advanced chronic kidney disease (ACKD), improving their survival and reducing morbidity in this phase of the disease. Nowadays, there is not much evidence in the Spanish and international literature regarding the structure and how to achieve these objectives in the UERCA. From the ERCA working group of the Spanish Society of Nephrology (SEN), this project is promoted to improve care for ERCA patients through the definition of quality standards for the operation of the UERCA. MATERIAL AND METHODS An initial proposal for quality standards concerning the operation of the UERCA was configured through consultation with the main sources of references and the advice of an expert working group through face-to-face and telematic meetings. Base on this initial proposal of standards, a survey was conducted and sent it via email to 121 nephrology specialist and nursing professionals with experience in Spanish UERCA to find out, among others, the suitability of each standards, that is, its mandatory nature or recommendation as standards. The access to the survey was allowed between July 16th, 2018, until September 26th, 2018. RESULTS A total of 95 (78.5%) professionals participated out of the 121 who were invited to participate. Of these, 80 of the participants were nephrology specialists and 15 nursing professionals, obtaining a varied representation of professionals from the Spanish geography. After analyzing the opinions of these participants, the standards were defined to a total of 68, 37 of them (54.4%) mandatory and 31 of them (45.5%) recommended. Besides, it was observed that the volume of patients attended in the UERCA is usually above 100 patients, and the referral criteria is generally below 25-29 mL/min/1.73 m2 of glomerular filtration. CONCLUSIONS This work constitutes a first proposal of quality standards for the operation of UERCA in Spain. The definition of these standards has made it possible to establish the bases for the standardization of the organization of UERCA, and to subsequently work on the configuration of a standards manual for the accreditation of ERCA Units.
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Affiliation(s)
- Mario Prieto-Velasco
- Servicio de Nefrología, Complejo Asistencial Universitario de León, León, España
| | | | | | | | - Ramón Pons Prades
- Servicio de Nefrología, Hospital General Universitario Castellón, Castellón, España
| | | | | | | | - Nicanor Vega Díaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, España
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Winterbottom AE, Mooney A, Russon L, Hipkiss V, Williams R, Ziegler L, Bekker HL. Critical review of leaflets about conservative management used in uk renal services. J Ren Care 2020; 46:250-257. [PMID: 32270601 DOI: 10.1111/jorc.12327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Written information supplements nurse-led education about treatment options. It is unclear if this information enhances patients' reasoning about conservative management (CM) and renal replacement therapy decisions. AIM This study describes a critical review of resources U.K. renal staff use when providing CM options to people with Established Kidney Disease (EKD) during usual pre-dialysis education. DESIGN A survey using mixed methods identified and critically analysed leaflets about CM. PARTICIPANTS & MEASUREMENTS All 72 renal units in the United Kingdom received an 11-item questionnaire to elicit how CM education is delivered, satisfaction and/or needs with patient resources and staff training. Copies of leaflets were requested. A coding frame was utilised to produce a quality score for each leaflet. RESULTS Fifty-four (75%) units participated. Patients discuss CM with a nephrologist (98%) or nurse (100%). Eighteen leaflets were reviewed, mean scores were 8.44 out of 12 (range 5-12, SD = 2.49) for information presentation; 3.50 out of 6 (range 0-6, SD = 1.58) for inclusion of information known to support shared decision-making and 2.28 out of 6 (range 1-4, SD = 0.96) for presenting non-biased information. CONCLUSIONS Nurses preferred communicating via face-to-face contact with patients and/or families because of the emotional consequences and complexity of planning treatment for the next stage of a person's worsening kidney disease. Conversations were supplemented with written information; 66% of which were produced locally. Staff perceived a need for using leaflets, and spend time and resources developing them to support their services. However, no leaflets included the components needed to help people reason about conservative care and renal replacement therapy options during EKD education consultations.
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Affiliation(s)
- Anna E Winterbottom
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Andrew Mooney
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Lynne Russon
- Sue Ryder Care, Wheatfields Hospice, Grove Road, Headingley, Leeds, LS6 2AE, UK
| | - Vicki Hipkiss
- Bradford Renal Unit, Horton Wing, St. Luke's Hospital, 1st Floor, Little Horton Lane, West Yorkshire, BD5 0NA, UK
| | - Richard Williams
- Adult Renal Services, Lincoln Wing, St. James University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Worsley Building-Level 10, Clarendon Way, Leeds, LS2 9NL, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Worsley Building-Level 10, Clarendon Way, Leeds, LS2 9NL, UK
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Cassidy BP, Getchell LE, Harwood L, Hemmett J, Moist LM. Barriers to Education and Shared Decision Making in the Chronic Kidney Disease Population: A Narrative Review. Can J Kidney Health Dis 2018; 5:2054358118803322. [PMID: 30542621 PMCID: PMC6236635 DOI: 10.1177/2054358118803322] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/21/2018] [Indexed: 12/13/2022] Open
Abstract
PURPOSE OF REVIEW Provision of education to inform decision making for renal replacement therapy (RRT) is a key component in the management of chronic kidney disease (CKD), yet patients report suboptimal satisfaction with the process of selecting a dialysis modality. Our purpose is to review the influencers of RRT decision making in the CKD population, which will better inform the process of shared decision making between clinicians and patients. SOURCES OF INFORMATION PubMed and Google Scholar. METHODS A narrative review was performed using the main terms "chronic kidney disease," "CKD," "dialysis," "review," "decision-making," "decision aids," "education," and "barriers." Only articles in English were accessed. The existing literature was critically analyzed from a theoretical and contextual perspective and thematic analysis was performed. KEY FINDINGS Eight common themes were identified as influencers for decision making. "Patient-focused" themes including social influence, values and beliefs, comprehension, autonomy and sociodemographics, and "clinician-focused" themes including screening, communication, and engagement. Early predialysis education and decision aids can effectively improve decision making. Patient-valued outcomes need to be more fully integrated into clinical guidelines. LIMITATIONS This is not a systematic review; therefore, no formal tool was utilized to evaluate the rigor and quality of studies included and findings may not be generalizable. IMPLICATIONS Standardized comprehensive RRT education programs through multidisciplinary health teams can help optimize CKD patient education and shared decision making. Involving patients in the research process itself and implementing patient values and preferences into clinical guidelines can help to achieve a patient-centered model of care.
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Affiliation(s)
- Brendan P. Cassidy
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Leah E. Getchell
- Kidney, Dialysis and Transplantation
Program, ICES Western, London, ON, Canada
| | - Lori Harwood
- Renal Services, London Health Sciences
Centre, London, ON, Canada
| | - Juliya Hemmett
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
| | - Louise M. Moist
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, London
Health Sciences Centre, London, ON, Canada
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Cassidy BP, Harwood L, Getchell LE, Smith M, Sibbald SL, Moist LM. Educational Support Around Dialysis Modality Decision Making in Patients With Chronic Kidney Disease: Qualitative Study. Can J Kidney Health Dis 2018; 5:2054358118803323. [PMID: 30327720 PMCID: PMC6178119 DOI: 10.1177/2054358118803323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with chronic kidney disease (CKD) are asked to choose a renal replacement therapy or conservative management. Education and knowledge transfer play key roles in this decision-making process, yet they remain a partially met need. OBJECTIVE We sought to understand the dialysis modality decision-making process through exploration of the predialysis patient experience to better inform the educational process. DESIGN Qualitative descriptive study. SETTING Kidney Care Centre of London Health Sciences Centre in London, Ontario, Canada. PATIENTS Twelve patients with CKD, with 4 patients on in-center hemodialysis, home hemodialysis, and peritoneal dialysis, respectively. MEASUREMENTS Not applicable. METHODS We conducted semistructured interviews with each participant, along with any family members who were present. Interviews were transcribed verbatim. Conventional content analysis was used to analyze the transcripts for common themes. Representative quotes were decided via team consensus. A patient collaborator was part of the research team. RESULTS Three themes influenced dialysis modality decision making: (i) Patient Factors: individualization, autonomy, and emotions; (ii) Educational Factors: tailored education, time and preparation, and available resources; and (iii) Support Systems: partnership with health care team, and family and friends. LIMITATIONS Sample not representative of wider CKD population. Limited number of eligible patients. Poor recall may affect findings. CONCLUSIONS Modality decision making is a complex process, influenced by the patient's health literacy, willingness to accept information, predialysis lifestyle, support systems, and values. Patient education requires the flexibility to individualize the delivery of a standardized CKD curriculum in partnership with a patient-health care team, to fulfill the goal of informed, shared decision making.
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Affiliation(s)
- Brendan P. Cassidy
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
| | - Lori Harwood
- Renal Services, London Health Sciences
Centre, London, ON, Canada
| | - Leah E. Getchell
- Institute for Clinical Evaluative
Sciences, Kidney Dialysis and Transplantation Research Program, London, ON,
Canada
| | - Michael Smith
- Renal Patient and Family Advisory
Council, London Health Sciences Centre, London, ON, Canada
| | - Shannon L. Sibbald
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
| | - Louise M. Moist
- Schulich School of Medicine and
Dentistry, Western University, London, ON, Canada
- Kidney Clinical Research Unit, Division
of Nephrology, Western University, London, ON, Canada
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11
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Chen NH, Lin YP, Liang SY, Tung HH, Tsay SL, Wang TJ. Conflict when making decisions about dialysis modality. J Clin Nurs 2017; 27:e138-e146. [PMID: 28543737 DOI: 10.1111/jocn.13890] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 02/02/2023]
Abstract
AIMS AND OBJECTIVES To explore decisional conflict and its influencing factors on choosing dialysis modality in patients with end-stage renal diseases. The influencing factors investigated include demographics, predialysis education, dialysis knowledge, decision self-efficacy and social support. BACKGROUND Making dialysis modality decisions can be challenging for patients with end-stage renal diseases; there are pros and cons to both haemodialysis and peritoneal dialysis. Patients are often uncertain as to which one will be the best alternative for them. This decisional conflict increases the likelihood of making a decision that is not based on the patient's values or preferences and may result in undesirable postdecisional consequences. Addressing factors predisposing patients to decisional conflict helps to facilitate informed decision-making and then to improve healthcare quality. DESIGN A predictive correlational cross-sectional study design was used. METHODS Seventy patients were recruited from the outpatient dialysis clinics of two general hospitals in Taiwan. Data were collected with study questionnaires, including questions on demographics, dialysis modality and predialysis education, the Dialysis Knowledge Scale, the Decision Self-Efficacy scale, the Social Support Scale, and the Decisional Conflict Scale. RESULTS The mean score on the Decisional Conflict Scale was 29.26 (SD = 22.18). Decision self-efficacy, dialysis modality, predialysis education, professional support and dialysis knowledge together explained 76.4% of the variance in decisional conflict. CONCLUSIONS Individuals who had lower decision self-efficacy, did not receive predialysis education on both haemodialysis and peritoneal dialysis, had lower dialysis knowledge and perceived lower professional support reported higher decisional conflict on choosing dialysis modality. RELEVANCE TO CLINICAL PRACTICE When providing decisional support to predialysis stage patients, practitioners need to increase patients' decision self-efficacy, provide both haemodialysis and peritoneal dialysis predialysis education, increase dialysis knowledge and provide professional support.
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Affiliation(s)
- Nien-Hsin Chen
- Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Shalunhu, Houlong Township, Miaoli County, Taiwan
| | - Yu-Ping Lin
- Department of Nursing, Oriental Institute of Technology, Taipei, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Heng-Hsin Tung
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | | | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Winterbottom A, Bekker H, Mooney A. Dialysis modality selection: physician guided or patient led? Clin Kidney J 2016; 9:823-825. [PMID: 27994862 PMCID: PMC5162419 DOI: 10.1093/ckj/sfw109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 11/14/2022] Open
Abstract
The process of choosing dialysis modality for patients is complex and requires input from the expert renal team. Although it is commonplace for nephrologists to recommend dialysis modalities to patients, this might not always lead to the patient receiving treatment which they regard as most suitable. Nephrologists should consider whether it is appropriate for pre-dialysis education to be directive, or whether the choice between treatment options should be led by the patient.
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Affiliation(s)
| | - Hilary Bekker
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Andrew Mooney
- Renal Unit, St James's University Hospital, Leeds, UK
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Winterbottom AE, Gavaruzzi T, Mooney A, Wilkie M, Davies SJ, Crane D, Tupling K, Baxter PD, Meads DM, Mathers N, Bekker HL. Patient Acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) Booklet: A Prospective Non-Randomized Comparison Study Across 6 Predialysis Services. Perit Dial Int 2016; 36:374-81. [PMID: 26429419 PMCID: PMC4934429 DOI: 10.3747/pdi.2014.00274] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 05/14/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND Patients are satisfied with their kidney care but want more support in making dialysis choices. Predialysis leaflets vary across services, with few being sufficient to enable patients' informed decision making. We describe the acceptability of a patient decision aid and feasibility of evaluating its effectiveness within usual predialysis practice. ♦ METHODS Prospective non-randomized comparison design, Usual Care or Usual Care Plus Yorkshire Dialysis Decision Aid Booklet (+YoDDA), in 6 referral centers (Yorkshire-Humber, UK) for patients with sustained deterioration of kidney function. Consenting (C) patients completed questionnaires after predialysis consultation (T1), and 6 weeks later (T2). Measures assessed YoDDA's utility to support patients' decisions and integration within usual care. ♦ RESULTS Usual Care (n = 105) and +YoDDA (n = 84) participant characteristics were similar: male (62%), white (94%), age (mean = 62.6; standard deviation [SD] 14.4), kidney disease severity (glomerular filtration rate [eGFR] mean = 14.7; SD 3.7); decisional conflict was < 25; choice-preference for home versus hospital dialysis approximately 50:50. Patients valued receiving YoDDA, reading it on their own (96%), and sharing it with family (72%). The +YoDDA participants had higher scores for understanding kidney disease, reasoning about options, feeling in control, sharing their decision with family. Study engagement varied by center (estimated range 14 - 49%; mean 45%); participants varied in completion of decision quality measures. ♦ CONCLUSIONS Receiving YoDDA as part of predialysis education was valued and useful to patients with worsening kidney disease. Integrating YoDDA actively within predialysis programs will meet clinical guidelines and patient need to support dialysis decision making in the context of patients' lifestyle.
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Affiliation(s)
- Anna E Winterbottom
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - Teresa Gavaruzzi
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | | | | | - Simon J Davies
- Institute for Science & Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK
| | - Dennis Crane
- National Kidney Federation Advocacy Officer, Manchester, UK
| | - Ken Tupling
- Kidney Patient Association, Sheffield Area Kidney Association, Northern General Hospital, Sheffield, UK
| | - Paul D Baxter
- Division of Epidemiology & Biostatistics LIGHT - School of Medicine, University of Leeds, Leeds, UK
| | - David M Meads
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
| | - Nigel Mathers
- Academic Unit of Primary Medical Care, Northern General Hospital, Herries Road, Sheffield, UK
| | - Hilary L Bekker
- Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK
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14
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Marrón B, Ostrowski J, Török M, Timofte D, Orosz A, Kosicki A, Całka A, Moro D, Kosa D, Redl J, Qureshi AR, Divino-Filho JC. Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting. PLoS One 2016; 11:e0155987. [PMID: 27228101 PMCID: PMC4882011 DOI: 10.1371/journal.pone.0155987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/06/2016] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis. OBJECTIVES To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics. METHODS Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012. Scheduled initiation of dialysis with a permanent access was considered as planned RRT start. RESULTS Modality information (80% of patients) and renal education (87%) were more frequent (p<0.001) in Planned (P) than in Non-Planned (NP) start. Median time from information to dialysis start was 2 months. 89% of patients started on hemodialysis, 49% were referred late to ICS (<3 months from referral to RRT) and 58% were NP start. Late referral, non-vascular renal etiology, worse clinical status, shorter time from information to RRT and less peritoneal dialysis (PD) were associated with NP start (p<0.05). In multivariate logistic regression analysis, P start (p≤0.05) was associated with early referral, eGFR >8.2 ml/min, >2 months between information and RRT initiation and with vascular etiology after adjustment for age and gender. "Optimal care," defined as ICS follow-up >12 months plus modality information and P start, occurred in 23%. CONCLUSIONS Despite the high rate of late referrals, information and education were widely provided. However, NP start was high and related to late referral and may explain the low frequency of PD.
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Affiliation(s)
- Belén Marrón
- Diaverum Home Therapies, Medical Office, Munich, Germany
| | | | | | | | | | | | | | - Daniela Moro
- Sibiu Distributei Diaverum Clinic, Sibiu, Romania
| | - Dezider Kosa
- Zalaegerszeg Diaverum Clinic, Zalaegerszeg, Hungary
| | - Jenö Redl
- Szolnok Diaverum Clinic, Szolnok, Hungary
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Prieto-Velasco M, Quiros P, Remon C. The Concordance between Patients' Renal Replacement Therapy Choice and Definitive Modality: Is It a Utopia? PLoS One 2015; 10:e0138811. [PMID: 26466387 PMCID: PMC4605797 DOI: 10.1371/journal.pone.0138811] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 09/03/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION It is desirable for patients to play active roles in the choice of renal replacement therapy (RRT). Patient decision aid tools (PDAs) have been developed to allow the patients to choose the option best suited to their individual needs. MATERIAL AND METHODS An observational, prospective registry was conducted in 26 Spanish hospitals between September 2010 and May 2012. The results of the patients' choice and the definitive RRT modality were registered through the progressive implementation of an Education Process (EP) with PDAs designed to help Chronic Kidney Disease (CKD) patients choose RRT. RESULTS Patients included in this study: 1044. Of these, 569 patients used PDAs and had made a definitive choice by the end of registration. A total of 88.4% of patients chose dialysis [43% hemodialysis (HD) and 45% peritoneal dialysis (PD)] 3.2% preemptive living-donor transplant (TX), and 8.4% conservative treatment (CT). A total of 399 patients began RRT during this period. The distribution was 93.4% dialysis (53.6% HD; 40% PD), 1.3% preemptive TX and 5.3% CT. The patients who followed the EP changed their mind significantly less often [kappa value of 0.91 (95% CI, 0.86-0.95)] than those who did not follow it, despite starting unplanned treatment [kappa value of 0.85 (95% CI, 0.75-0.95]. A higher agreement between the final choice and a definitive treatment was achieved by the EP and planned patients [kappa value of 0.93 (95% CI, 0.89-0.98)]. Those who did not go through the EP had a much lower index of choosing PD and changed their decision more frequently when starting definitive treatment [kappa value of 0.73 (95% CI, 0.55-0.91)]. CONCLUSIONS Free choice, assisted by PDAs, leads to a 50/50 distribution of PD and HD choice and an increase in TX choice. The use of PDAs, even with an unplanned start, achieved a high level of concordance between the chosen and definitive modality.
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Affiliation(s)
- Mario Prieto-Velasco
- Department of Nephrology, Complejo Asistencial Universitario de León, León, Spain
- * E-mail:
| | - Pedro Quiros
- Department of Nephrology, Hospital Universitario de Puerto Real, Puerto Real, Spain
| | - Cesar Remon
- Department of Nephrology, Hospital Universitario de Puerto Real, Puerto Real, Spain
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Goovaerts T, Bagnis Isnard C, Crepaldi C, Dean J, Melander S, Mooney A, Prieto‐Velasco M, Trujillo C, Zambon R, Nilsson E. Continuing education: preparing patients to choose a renal replacement therapy. J Ren Care 2015; 41:62-75. [PMID: 25597792 PMCID: PMC7328707 DOI: 10.1111/jorc.12106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines OBJECTIVES To provide nurses with advice and guidance on running RRTOE. DESIGN A consensus conference. PARTICIPANTS Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. APPROACH Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. RESULTS Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. CONCLUSIONS Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. APPLICATION TO PRACTICE There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal - providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.
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Affiliation(s)
- Tony Goovaerts
- Cliniques Universitaires St LucService de NéphrologieBrusselsBelgium
| | - Corinne Bagnis Isnard
- Service de Néphrologie, Groupe Hospitalier Pitié‐Salpêtrière et Chaire de Recherche en Education ThérapeutiqueUniversité Pierre et Marie CurieParisFrance
| | - Carlo Crepaldi
- Unità Operativa di NefrologiaDialisi e TrapiantoOspedale San BortoloVicenzaItaly
| | - Jessica Dean
- Department of Clinical Health PsychologySalford Royal HospitalSalfordUK
| | - Stefan Melander
- Department of NephrologyUniversity Hospital of LinköpingLinköpingSweden
| | - Andrew Mooney
- Renal UnitSt James's University Hospital, Leeds Teaching Hospitals NHS TrustLeedsUK
| | | | - Carmen Trujillo
- Unidad clínica de Gestión de NefrologíaHospital Regional Carlos HayaMalagaSpain
| | - Roberto Zambon
- Unità Operativa di NefrologiaDialisi e TrapiantoOspedale San BortoloVicenzaItaly
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