The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: A randomized trial
The impact of education on chronic kidney disease patients' plans to initiate dialysis with self-care dialysis: A randomized trial
复制标题
DOI：
10.1111/j.1523-1755.2005.00594.x
复制
发表时间：
2005-10-01
影响因子：
19.6
通讯作者：
McLaughlin, K
中科院分区：
文献类型：
--
作者：
Manns, BJ;Taub, K;McLaughlin, K
背景与中心内血液透析相比，自我护理透析（包括家庭和自我护理血液透析和腹膜透析）的资源密集度更低，且临床结局相似。然而，自我护理透析的利用率非常低。我们在慢性肾脏病（CKD）（GFR < 30 mL/min）透析前患者中进行了一项随机对照试验，以确定以患者为中心的教育干预对患者开始自我护理透析的意图的影响。70名在多学科透析前门诊接受治疗的CKD患者被随机分为两组，接受（1）以患者为中心的两阶段教育干预（第一阶段包括教育小册子和一段15分钟关于自我护理透析的录像;第2阶段包括90分钟的自我护理透析小组互动教育课程），除了常规的多学科护理外，或（2）在多学科透析前诊所进行标准护理和教育。主要结果是患者开始自我护理透析透析的意愿，通过评估。35名患者随机接受标准治疗; 34名完成研究。35名患者随机接受教育干预; 30名完成了第1阶段，28名完成了第2阶段。到研究结束时，干预组（82.1%）打算开始自我护理透析的患者明显多于标准治疗组（50%，P= 0.015）。在控制了两个研究组患者之间较小的基线差异后，这种差异仍然存在（P= 0.004）。两阶段教育干预可以增加打算开始自我护理透析的患者比例。
Background. Compared with in-center hemodialysis, self-care dialysis (including home and self-care hemodialysis and peritoneal dialysis) is less resource intensive and associated with similar clinical outcomes. However, utilization of self-care dialysis has been very low. We performed a randomized controlled trial in predialysis patients with chronic kidney disease (CKD) (GFR < 30 mL/min) to determine the impact of a patient-centered educational intervention on patients' intention to initiate dialysis with self-care dialysis.Methods. Seventy patients with CKD who were receiving care in a multidisciplinary predialysis clinic were randomized to receive either (1) a two-phase patient-centered educational intervention (phase 1 included educational booklets and a 15-minute video on self-care dialysis; phase 2 included a 90-minute small group interactive educational session on self-care dialysis) in addition to their regular multidisciplinary care, or (2) ongoing standard care and education in the multidisciplinary predialysis clinic. The primary outcome was patients' intention to initiate dialysis with self-care dialysis, assessed by questionnaire.Results. Thirty-five patients were randomized to standard care; 34 completed the study. Thirty-five patients were randomized to the educational intervention; 30 completed phase 1 and 28 completed phase 2. By study end, significantly more patients in the intervention group (82.1%) intended to start dialysis with self-care dialysis compared with the standard care group (50%, P= 0.015). This difference persisted after controlling for the small baseline differences among patients in the two study groups (P= 0.004).Conclusion. A two-phase educational intervention can increase the proportion of patients who intend to initiate dialysis with self-care dialysis.