Rachael Walker|Kirsten Howard|Rachael L. Morton
Patient Education and Choice of Peritoneal Dialysis
University of Sydney|University of Sydney|University of Sydney|National Health and Medical Research Council
related article p 422 related article p 422 economic social individual burden endstage kidney disease continues increase internationally united states endstage kidney disease program accounts 6 total cost governments medicare budget1collins aj foley rn chavers b et alus renal data system 2013 annual data reportam j kidney dis 2014 63 e1e420pubmed google scholar many countries exploring ways reduce financial burden one encourage use homebased peritoneal dialysis pd less expensive modality facility hemodialysis hd1collins aj foley rn chavers b et alus renal data system 2013 annual data reportam j kidney dis 2014 63 e1e420pubmed google scholar many countries pd remains significantly underused2saran r li robinson b et alus renal data system 2014 annual data report epidemiology kidney disease united statesam j kidney dis 2015 66 s1s306pubmed google scholar despite offering number benefits patient treatment flexibility independence importance patientspecific outcomes impact patient decision making patient centeredness care becoming apparent health policy research3selby jv beal ac frank l patientcentered outcomes research institute pcori national priorities research initial research agendajama 2012 307 15831584crossref pubmed scopus 444 google scholar patient centeredness shared decision making endstage kidney disease hold central importance due impact dialysis physical emotional social qualityoflife outcomes patients families use dialysis decision aids patient education programs increasing evidence suggests effective tools promote informed patient decision making endstage kidney disease also influence choice uptake pd4fortnum smolonogov walker r kairaitis l pugh kidneys choice decision aid supporting shared decisionmakingj renal care 2015 41 8187crossref pubmed scopus 39 google scholar 5winterbottom ae gavaruzzi mooney et al patient acceptability yorkshire dialysis decision aid yodda booklet prospective nonrandomized comparison study across 6 predialysis services published online ahead print october 1 2015 perit dial int httpdxdoiorg103747pdi201400274google scholar small number studies report patient decision making renal replacement therapies discuss factors influencing patient choices6tong lesmana b johnson dw wong g campbell craig jc perspectives adults living peritoneal dialysis thematic synthesis qualitative studiesam j kidney dis 2013 61 873888abstract full text full text pdf pubmed scopus 85 google scholar 7walker rc hanson cs palmer sc et alpatient caregiver perspectives home hemodialysis systematic reviewam j kidney dis 2015 65 451463abstract full text full text pdf pubmed scopus 112 google scholar also convincing evidence predialysis education improves initiation renal replacement therapy substantially increases patient selection pd8korevaar jc feith g dekker fw et aleffect starting hemodialysis compared peritoneal dialysis patients new dialysis treatment randomized controlled trialkidney int 2003 64 22222228abstract full text full text pdf pubmed scopus 340 google scholar 9blake pg quinn rr oliver mj peritoneal dialysis process modality selectionperit dial int 2013 33 233241crossref pubmed scopus 58 google scholar international guidelines recommend education treatment modalities patients approaching dialysis10stevens pe levin kdigo work groupevaluation management chronic kidney disease synopsis kidney disease improving global outcomeskidney int 2012 825830google scholar 11national institute care excellence guidance home compared hospital haemodialysis patients endstage renal failure 2002 httpwwwniceorguknicemedialive114723244932449pdf accessed april 10 2016google scholar despite evidence imminent pressure increase pd use internationally predialysis education remains one underresearched areas nephrology issue ajkd devoe et al12devoe dj wong b james mt et alpatient education peritoneal dialysis modality selection systematic review metaanalysisam j kidney dis 2016 68 422433google scholar provide comprehensive review influence predialysis educational interventions patients predialysis choice pd actual initiation pd therapy systematic review metaanalysis summarizes findings 15 studies including one randomized controlled trial rct devoe et al included 2 outcomes primary outcome choosing pd defined intention use pd regardless whether pd ever used secondary outcome receiving pd defined individual receiving pd treatment devoe et al found compared standard care patienttargeted modality education associated 46fold increase odds patients choosing pd rct 21fold increase odds choosing pd based 4 observational studies addition found 35fold increase odds patients receiving pd initial dialysis modality based 9 observational studies strength review devoe et al inclusion dual outcomes ie choosing receiving pd however 1 rct identified 1 study reported outcomes patient choice receipt pd 1 rct highlights one challenges conducting rcts area patient choice stated preference ie chosen modality revealed preference ie modality actually received different outcomes similar challenges experienced conduct netherlands cooperative study adequacy dialysis necosad aimed monitor quality adequacy dialysis treatment following random selection initial treatment modality predialysis phase patients educated hd pd according usual local care however trial stopped early due poor patient recruitment 50 patients exhibited strong preference pd declined randomly assigned study continued longitudinal cohort study enrolling patients agreed randomly assigned chosen modality8korevaar jc feith g dekker fw et aleffect starting hemodialysis compared peritoneal dialysis patients new dialysis treatment randomized controlled trialkidney int 2003 64 22222228abstract full text full text pdf pubmed scopus 340 google scholar addition dilemma comprehensively evaluate components educational interventions models predialysis education impact receiving pd still exist despite acknowledgement importance predialysis education best practice guidelines recommendations constitutes effective predialysis education lack guidelines heterogeneity predialysis programs may account regional international variability pd home hd uptake predialysis education rarely evaluated effectiveness actual dialysis uptake meeting needs new patients families absence future rcts longitudinal studies may provide effective approach evaluating predialysis programs stated preference methods discrete choice experiments may also help us understand patients value specific aspects multidimensional education programs preferences might influence dialysis modality choice given findings studies conducted date devoe et al concluded educational approach tested identified rct current best educational strategy however rightly caution area remains poorly understood results recent research suggest development patientfocused educational programs resources engage patients better emphasized also suggest predialysis pd education programs cover health literacy concentrate cultural social values decrease fears engender confidence decisions13walker rc howard k morton rl palmer sc marshall mr tong patient caregiver values beliefs experiences considering home dialysis treatment option semistructured interview studynephrol dial transplant 2016 31 133141crossref pubmed scopus 76 google scholar understanding components education program effective best person deliver information stages ckd frequently whether patient choice correlates actual receipt pd remain unanswered questions importantly devoe et al highlight additional factors extend beyond patient choice influencing patients receiving pd including health system provider factors clinician behavior late referrals increasing recognition importance clinician preferences practice patterns determining use pd terms program development promotion service level14hingwala j diamond j tangri n et alunderutilization peritoneal dialysis role nephrologists referral patternnephrol dial transplant 2013 28 732740crossref pubmed scopus 23 google scholar embrace patientcentered approach encourage patient choice role importance clinician recommendation particularly late starters still debated divergent views among clinicians patients optimal balance clinician choicerecommendation individual patient choice unique finding study devoe et al education late starters still effective promoting pd contradicts studies15arramreddy r zheng saxena ab liebman se wong l urgentstart peritoneal dialysis chance new beginningam j kidney dis 2014 63 390395abstract full text full text pdf pubmed scopus 62 google scholar requires research finding also highlights need develop innovative strategies address suboptimal initiation dialysis therapy urgentstart pd educational programs targeting group would expected programs need differ early tailored predialysis programs study devoe et al important limitations acknowledged relative paucity highquality studies impact education pd uptake studies analyzed demonstrated statistical heterogeneity choosing pd devoe et al concluded may explained differences study populations interventions across studies additionally fact less half observational studies provided description control intervention contributed complexity interpretation limitations underlie part call methodologically robust studies evaluate predialysis programs finally due limited number studies available metaregression could effectively evaluate efficacy educational program components varied considerably among studies leaving us question components predialysis education effective conclusion emphasis patientcentered outcomes shared decision making patients kidney disease imperative advance understanding effective education patients approaching endstage kidney disease point treatment choice devoe et al demonstrated benefits education patient choice receipt pd results build foundation future research components predialysis patient education align patient family educational needs support ms walker supported university sydney apa scholarship baxter clinical evidence council research program financial disclosure authors declare relevant financial interests peer review evaluated coeditor editorinchief patient education peritoneal dialysis modality selection systematic review metaanalysisamerican journal kidney diseasesvol 68issue 3previeweducational interventions increasingly used promote peritoneal dialysis pd common form home therapy endstage renal disease systematic review evidence support dialysis modality education needed inform design patienttargeted interventions increase selection pd performed systematic review metaanalysis characterize relationship patienttargeted educational interventions choosing receiving pd fulltext pdf