Educational Interventions in Kidney Disease Care: A Systematic Review of Randomized Trials

Jo, Mason; Khunti, Kamlesh; Stone, Margaret; Farooqi, Azhar; Carr, Sue

doi:10.1053/j.ajkd.2008.01.024

Cited by 124 publications

(120 citation statements)

References 27 publications

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“…[153][154][155] The three reviews were published between 2008 and 2012 and included a total of 32 RCTs, five of which were included in more than one review. RCTs were carried out in six countries: USA (the majority of studies), Canada, UK, Scotland, the Netherlands and Taiwan.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…RCTs were carried out in six countries: USA (the majority of studies), Canada, UK, Scotland, the Netherlands and Taiwan. The three reviews all focused on a different form of self-management support: Mason et al 153 focused on educational interventions; Matteson and Russell 154 explored interventions specifically aimed at increasing adherence to lifestyle and treatment; and Strand and Parker 155 studied multidisciplinary care (MDC). However, despite the varied focuses, all interventions tended to include one or more of the following three components: education about CKD and its management; psychological strategies; or lifestyle advice and support.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…154 In another, the majority of studies involved dialysis patients, with a small minority of studies including only pre-dialysis patients (CKD stages four and five). 153 The remaining review included only pre-dialysis patients, with CKD stage ranging from stage 3 to stage 5 155 (Table 57).…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…One review was classified as high quality 153 (scoring ≥ 31), whereas the remaining two were classified as being of lower quality 154,155 (scoring ≤ 30) ( Table 58). Considering both quality and size of the reviews, Mason et al 153 was considered the review to carry the largest weight of evidence with a three star rating, whereas both Matteson and Russell 154 and Strand and Parker 155 received a weight of just one star ( Table 59).…”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

“…Considering both quality and size of the reviews, Mason et al 153 was considered the review to carry the largest weight of evidence with a three star rating, whereas both Matteson and Russell 154 and Strand and Parker 155 received a weight of just one star ( Table 59). …”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

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A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

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BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Systematic Reviews Identifiedmentioning

confidence: 99%