Effectiveness of a health literacy intervention targeting kidney patients and professionals

Background

Chronic kidney disease (CKD) patients with limited health literacy (LHL) experience a faster kidney decline. To counteract this, we developed Grip on your Kidneys (GoyK). This intervention targets patients’ communication and self-management. It trains health care professionals (HCPs) competences to support patients with LHL. This study aims to test the effectiveness of GoyK on patients’ health and self-management, HCPs’ communication competences, and the quality of consultations.

Methods

A clustered and non-blinded quasi-experimental study was conducted, including 161 patients with mild to severe CKD and 48 HCPs from Dutch general practices and nephrology clinics. Patients (n = 77) and HCPs (n = 30) in the intervention group received GoyK. In the control group, patients (n = 76) had routine visits with HCPs (n = 19). Between March 2021 and June 2022, data were collected with questionnaires and from patient records at baseline (T0), 4 months (T1) and 9 months (T2). Primary outcomes were patients’ self-management and HCPs’ use of health literacy communication strategies.

Preliminary results

At T1, the intervention improved the days per week patients exercised (B = 1.00, 95% confidence interval, CI = 0.35-1.65, P = 0.003), and Likert-scale reported (1-4) fluid intake (B = 0.37, CI = 0.10-0.63, p = 0.006). The intervention had a positive effect on several outcomes related to how patients perceived the consultation quality, and improved the reported use of communication strategies by HCPs at T1 (B = 0.68, CI = 0.35-1.01, p = <0.001). We found no effects on other patient outcomes, like activation for self-management or salt intake.

Conclusions

Our health literacy intervention, targeting CKD patients with LHL and HCPs, improved lifestyle behaviors of patients and the quality of consultations. A further strengthening of other self-management behaviors and on HCPs’ competences is needed, also to reach sustainable effects in the care for patients with LHL.

Key messages

• A health literacy intervention, targeting patients and professionals simultaneously, improved the patients’ self-management and care consultations.

• Training of HCPs improved their competences to support patients with LHL, and care organizations and studies need to implement education on this topic.

Treatment goals and changes over time in older patients with non-curable cancer

PURPOSE

To investigate the treatment goals of older patients with non-curable cancer, whether those goals changed over time, and if so, what triggered those changes.

METHODS

We performed a descriptive and qualitative analysis using the Outcome Prioritization Tool (OPT) to assess patient goals across four conversations with general practitioners (GPs) over 6 months. Text entries from electronic patient records (hospital and general practice) were then analyzed qualitatively for this period.

RESULTS

Of the 29 included patients, 10 (34%) rated extending life and 9 (31%) rated maintaining independence as their most important goals. Patients in the last year before death (late phase) prioritized extending life less often (3 patients; 21%) than those in the early phase (7 patients; 47%). Goals changed for 16 patients during follow-up (12 in the late phase). Qualitative analysis revealed three themes that explained the baseline OPT scores (prioritizing a specific goal, rating a goal as unimportant, and treatment choices related to goals). Another three themes related to changes in OPT scores (symptoms, disease course, and life events) and stability of OPT scores (stable situation, disease-unrelated motivation, and stability despite symptoms).

CONCLUSION

Patients most often prioritized extending life as the most important goal. However, priorities differed in the late phase of the disease, leading to changed goals. Triggers for change related to both the disease (e.g., symptoms and course) and to other life events. We therefore recommend that goals should be discussed repeatedly, especially near the end of life.

TRIAL REGISTRATION

OPTion study: NTR5419.

Correspondence between primary and secondary care about patients with cancer: a Delphi consensus study

INTRODUCTION

To provide optimal care for patients with cancer, timely and efficient communication between healthcare providers is essential. In this study, we aimed to achieve consensus regarding the desired content of communication between general practitioners (GPs) and oncology specialists before and during the initial treatment of cancer.

METHODS

In a two-round Delphi procedure, three expert panels reviewed items recommended for inclusion on referral and specialist letters.

RESULTS

The three panels comprised 39 GPs (42%), 42 oncology specialists (41%) (i.e. oncologists, radiotherapists, urologists and surgeons) and 18 patients or patient representatives (69%). Final agreement was by consensus, with 12 and 35 items included in the GP referral and the specialist letters, respectively. The key requirements of GP referral letters were that they should be limited to medical facts, a short summary of symptoms and abnormal findings, and the reason for referral. There was a similar requirement for letters from specialists to include these same medical facts, but detailed information was also required about the diagnosis, treatment options and chosen treatment. After two rounds, the overall content validity index (CVI) for both letters was 71%, indicating that a third round was not necessary.

DISCUSSION

This is the first study to differentiate between essential and redundant information in GP referral and specialist letters, and the findings could be used to improve communication between primary and secondary care.

A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner?

Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.

Contribution of postprandial amino acid levels to stimulation of insulin, glucagon, and pancreatic polypeptide in humans

The present study was designed to examine the contribution of the postprandial increase of plasma amino acids after ingestion of a protein-rich meal to the rise of the three pancreatic hormones insulin, glucagon, and pancreatic polypeptide (PP). A mixed amino acid solution was designed, which permitted a fairly close imitation of the arterial plasma pattern of the 21 amino acids that rise after ingestion of a 200-g porcine steak meal. In 10 healthy subjects the intravenous infusion of this mixed amino acid solution at a rate of 10 g/h elicited a rise of the 21 amino acids examined that correlated well with the postprandial increase (r = 0.89, p < 0.001). The maximal rise of plasma insulin (64 +/- 5 pmol/L) and glucagon (630 +/- 21 ng/L) was not significantly different from the postprandial increase of these two hormones (49 +/- 4 pmol/L and 780 +/- 28 ng/L, respectively). PP levels rose by 316 +/- 33 ng/L postprandially, which was clearly above the increase of 112 +/- 13 ng/L during intravenous amino acids (p < 0.01). In conclusion, the present data demonstrate that the postprandial rise of amino acid levels in arterialized venous plasma can account for most if not all of the postprandial increase of insulin and glucagon during the ingestion of a protein-rich meal. In contrast, only 35% of postprandial PP levels can be ascribed to the rise of plasma amino acids. In contrast to the effect of carbohydrate-rich meals, an enteric augmentation of insulin release seems to be of minor and possibly of no importance during ingestion of protein-rich meals.