A question prompt sheet for adult patients with chronic kidney disease

Abstract

BackgroundPatients with chronic kidney disease (CKD) commonly have unmet information needs. Greater patient participation in healthcare discussions can address these needs and improve health outcomes. We developed a patient-centered question prompt sheet (QPS) to engage CKD patients in healthcare conversations.MethodsWe conducted a two phase, mixed-methods, cross-sectional study involving semi-structured telephone interviews. Patients with an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2, on dialysis, or with a kidney transplant were recruited from one Veterans Affairs (VA) nephrology clinic. Phase 1 interviews included open-ended questions assessing patients’ CKD-related information needs and generated a preliminary 67-item QPS. Phase 2 interview participants rated the importance of asking each question on a 5-point Likert scale and provided open-ended feedback. All participants rated their willingness to use a CKD-QPS. Input from patient ratings, a multidisciplinary team, and from members of the National Kidney Disease Education Program (NKDEP) Coordinating Panel helped to shorten and refine the QPS. A qualitative thematic approach was used to analyze open-ended responses. Quantitative data were analyzed for means and proportions.ResultsEighty-five patients participated. Most were male (97 %), non-Hispanic white (71 %), and mean age was 67 years. Patients desired more information about CKD, particularly dialysis/transplant, and the relationship between CKD and comorbid medical conditions. The final QPS included 31-questions divided into 7 CKD subtopics. Most patients (88 %) reported being ‘completely’ or ‘very’ willing to use a CKD-QPS in future doctor visits.ConclusionsCKD patients have unmet information needs. We developed a QPS to engage CKD patients in healthcare discussions and to facilitate patient-centered care. Future research should assess whether the CKD-QPS addresses patients’ information needs, enhances doctor-patient communication, and improves health outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0362-z) contains supplementary material, which is available to authorized users.

Qualitative exploration of the experiences of renal dietitians and how they help patients with end stage kidney disease to understand the renal diet

“…From a practical perspective, the educational approaches used by renal dietitians must be effective, as well as pragmatic because of the resource and time constraints experienced by renal dietitians . Alternative educational approaches could include the use of question prompt lists; reducing the cognitive burden; using dialogue boards; or conversation maps and increasing the actionability of renal diet patient education resources . Further studies on the usefulness of improved printed patient education materials (such as diet sheets) and supermarket tours should also be undertaken …”

How do patients and carers make sense of renal dietary advice? A qualitative exploration

“…; Lederer et al . ); and by discussing appropriate information seeking practices with patients and carers (Bonner & Lloyd ). Reviewing the need for additional advice and education at an important renal diet transition point, such as when commencing a new RRT, is also recommended.…”

“…Clinicians, such as dietitians, could therefore better support patients to translate information about the renal diet by utilising additional strategies to promote sensemaking and to increase patient and carer knowledge and understanding (Loukanova et al 2007). This could be facilitated by using question prompt sheets prior to and during the appointment (Sansoni et al 2015;Lederer et al 2016); and by discussing appropriate information seeking practices with patients and carers (Bonner & Lloyd 2012). Reviewing the need for additional advice and education at an important renal diet transition point, such as when commencing a new RRT, is also recommended.…”

Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation

“…We hypothesized that kidney transplant recipients would be more effective as navigators, because they have already completed the steps in the transplant process. Other efforts to increase access to kidney transplantation include educating patients on dialysis about the option of transplantation, developing measures of transplant referral, streamlining the transplant workup, communicating with potential living donors, and disseminating data on rates of transplantation (15,(20)(21)(22)(23)(24).…”