Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective

Machowska, Anna; Alscher, Mark Dominik; Vanga, Satyanarayana Reddy; Koch, Michael; Aarup, Michael; Qureshi, Abdul Rashid; Lindholm, Bengt; Rutherford, Peter

doi:10.1186/s12882-016-0419-z

Cited by 24 publications

(44 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The findings of our present multicenter study, showing increased PD rates in UPS after an education program, are supported by several single center experiences [35-37] and a multicenter study by Machowska et al [38]. Interestingly, in logistic regression analysis the patient age significantly ( p < 0.0001) influenced PD modality choice.…”

Section: Discussionsupporting

confidence: 70%

Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Schanz

Ketteler

Heck

et al. 2017

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Up to 50% patients requiring dialysis receive an urgent, unplanned start (UPS) to renal replacement therapy (RRT). Most of these are initiated with an intravenous catheter and commenced and maintained on hemodialysis (HD). Although peritoneal dialysis (PD) could be an equipotent initial modality for RRT, it is used less frequently as long-term RRT in UPS patients. This multicenter-study aimed to evaluate the impact of a structured, in-hospital education program and factors influencing PD rates, especially in UPS patients. Methods: Three German nephrology departments collaborated to implement an in-hospital education program. Retrospective analysis included 336 subjects and compared the rates of HD and PD in consecutive patients who started RRT 12 months prior (two centers) and for 12 months after (three centers) implementing the education program. Results: PD rates increased significantly (p < 0.05) by 66% in all planned and unplanned dialysis starts after implementation of a structured, patient-centered education program. A highly significant (p < 0.0001) rise in utilization of PD was found, especially in UPS patients. In logistic regression analysis, PD modality choice was significantly influenced by age (p < 0.0001) and gender (p = 0.006). Conclusions: A structured, patient-centered in-hospital education program increases the frequency of PD in patients needing unplanned RRT. PD modality choice is significantly higher in young (p < 0.0001) and male (p = 0.006) patients.

show abstract

Section: Discussionsupporting

confidence: 70%

Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Schanz

Ketteler

Heck

et al. 2017

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…Three aids were available to the centers, with the educators choosing for individual patients from the Ottawa online decision aid, a self-completion balance scale, and a set of decision cards that allowed the patient to prioritize the value to them of specific issues and factors related to dialysis modalities. The detailed description of the program was presented previously elsewhere 12. UPS-EP tools are presented in Figure 1 (Swedish version of the educational package).…”

Section: Methodsmentioning

confidence: 99%

“…However, in single center studies, it has been shown to be possible, and that this results in increased incidence of PD choice 11. The Offering Patients Therapy Options in Unplanned Start (OPTiONS) was a multicenter observational study12 in Europe on the implementation of a UPS educational program (UPS-EP). USP-EP includes a specific educational program with decision support tools to promote shared decision making (SDM) within the context of a patient pathway improvement program.…”

Section: Introductionmentioning

confidence: 99%

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

Machowska¹,

Alscher²,

Vanga³

et al. 2016

PPA

Self Cite

View full text Add to dashboard Cite

ObjectivesUnplanned dialysis start (UPS) leads to worse clinical outcomes than planned start, and only a minority of patients ever receive education on this topic and are able to make a modality choice, particularly for home dialysis. This study aimed to determine the predictive factors for patients receiving education, making a decision, and receiving their preferred modality choice in UPS patients following a UPS educational program (UPS-EP).MethodsThe Offering Patients Therapy Options in Unplanned Start (OPTiONS) study examined the impact of the implementation of a specific UPS-EP, including decision support tools and pathway improvement on dialysis modality choice. Linear regression models were used to examine the factors predicting three key steps: referral and receipt of UPS-EP, modality decision making, and actual delivery of preferred modality choice. A simple economic assessment was performed to examine the potential benefit of implementing UPS-EP in terms of dialysis costs.ResultsThe majority of UPS patients could receive UPS-EP (214/270 patients) and were able to make a decision (177/214), although not all patients received their preferred choice (159/177). Regression analysis demonstrated that the initial dialysis modality was a predictive factor for referral and receipt of UPS-EP and modality decision making. In contrast, age was a predictor for referral and receipt of UPS-EP only, and comorbidity was not a predictor for any step, except for myocardial infarction, which was a weak predictor for lower likelihood of receiving preferred modality. Country practices predicted UPS-EP receipt and decision making. Economic analysis demonstrated the potential benefit of UPS-EP implementation because dialysis modality costs were associated with modality distribution driven by patient preference.ConclusionEducation and decision support can allow UPS patients to understand their options and choose dialysis modality, and attention needs to be focused on ensuring equity of access to educational programs, especially for the elderly. Physician practice and culture across units/countries is an important predictor of UPS patient management and modality choice independent of patient-related factors. Additional work is required to understand and improve patient pathways to ensure that modality preference is enacted. There appears to be a cost benefit of delivering education, supporting choice, and ensuring that the choice is enacted in UPS patients.

show abstract

“…According to a US Renal Data System report, 60% of patients who progress to ESRD have no distinct plan at the time of initiating dialysis therapy [3]. Although urgent-start HD via a CVC is usually used in this situation, it is associated with a high prevalence of complications and bacteremia [4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…Hemodialysis (HD) via a temporary central venous catheter (CVC) is the most frequently used dialysis modality in this situation. However, CVCs have been associated with increased risks of complications, including catheter-related infections, thrombosis, and bleeding, and also with mortality [4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

Jin¹,

Ni²,

Che³

et al. 2018

Blood Purif

View full text Add to dashboard Cite

Aims: This study aimed to compare the short-term complications and long-term prognosis between urgent-start peritoneal dialysis (PD) and hemodialysis (HD), and explore the safety and feasibility of PD in end-stage renal disease (ESRD) patients with diabetes. Methods: This retrospective study enrolled ESRD patients with diabetes who required urgent-start dialysis at a single center from January 2011 to December 2014. Short-term (30-day) dialysis-related complications and patient survival trends were compared between patients receiving PD and HD. Results: Eighty patients were included in the study, including 50 (62.5%) who underwent PD. The incidence of dialysis-related complications and complications requiring reinsertion during the first 30 days was significantly lower in PD patients. Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD. The patient survival rate was higher in the PD compared to that in the HD group. Conclusions: PD may be acceptable, safe, and feasible for urgent-start dialysis in ESRD patients with diabetes.

show abstract

Offering Patients Therapy Options in Unplanned Start (OPTiONS): Implementation of an educational program is feasible and effective

Cited by 24 publications

References 37 publications

Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation

Factors influencing access to education, decision making, and receipt of preferred dialysis modality in unplanned dialysis start patients

Peritoneal Dialysis as an Option for Unplanned Dialysis Initiation in Patients with End-Stage Renal Disease and Diabetes Mellitus

Contact Info

Product

Resources

About