Quality standards for predialysis education: results from a consensus conference

Bagnis, Corinne Isnard; Crepaldi, Carlo; Dean, Jessica; Goovaerts, Tony; Melander, Stefan; Nilsson, Eva-Lena; Prieto-Velasco, Mario; Trujillo, Carmen; Zambon, Roberto; Mooney, Andrew

doi:10.1093/ndt/gfu225

Cited by 33 publications

(28 citation statements)

References 29 publications

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“…This was developed in collaboration with 5 dialysis units in Europe and academic institutions specialized in patient education and aims at facilitate the decision making process for dialysis modality choice. There is no global consensus regarding the structure and content for modality education although standards have been suggested for planned start CKD education programs [22]. Programs tend to focus on general CKD knowledge, treatment as well as dialysis modality decisions [23].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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BackgroundPatients with unplanned dialysis start (UPS) have worse clinical outcomes than non-UPS patients, and receive peritoneal dialysis (PD) less frequently. In the OPTiONS study of UPS patients, an educational programme (UPS-EP) aiming at improving care of UPS patients by facilitating care pathways and enabling informed choice of dialysis modality was implemented. We here report on impact of UPS-EP on modality choice and clinical outcomes in UPS patients.MethodsThis non-interventional, prospective, multi-center, observational study included 270 UPS patients from 26 centers in 6 European countries (Austria, Germany, Denmark, France, United Kingdom and Sweden) who prior to inclusion presented acutely, or were being followed by nephrologists but required urgent dialysis commencement by an acutely placed CVC or PD catheter. Effects of UPS-EP on choice and final decision of dialysis therapy and outcomes within 12 months of follow up were analysed.ResultsAmong 270 UPS patients who had an unplanned start to dialysis, 214 were able to receive and 203 complete UPS-EP while 56 patients - who were older (p = 0.01) and had higher Charlson comorbidity index (CCI; p < 0.01) - did not receive UPS-EP. Among 177 patients who chose dialysis modality after UPS-EP, 103 (58%) chose PD (but only 86% of them received PD) and 74 (42%) chose HD (95% received HD). Logistic regression analysis showed that diabetes 1.88 (1.05 – 3.37) and receiving UPS-EP, OR = 4.74 (CI, 2.05 – 10.98) predicted receipt of PD. Patients choosing PD had higher CCI (p = 0.01), higher prevalence of congestive heart failure (p < 0.01) and myocardial infarction (p = 0.02), and were more likely in-patients (p = 0.02) or referred from primary care (p = 0.02). One year survival did not differ significantly between PD and HD patients. Peritonitis and bacteraemia rates were better than international guideline standards.ConclusionsUPS-EP predicted patient use of PD but 14% of those choosing PD after UPS-EP still did not receive the modality they preferred. Patient survival in patients choosing and/or receiving PD was similar to HD despite age and comorbidity disadvantages of the PD groups.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0419-z) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2017

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“…The program is focused on facilitating the decision-making process for patients choosing chronic RRT. There is no consensus regarding the structure and content for dialysis modality decision making, although standards have been suggested for planned start CKD education programs 13. Programs tend to focus on general knowledge about CKD and its treatment, as well as on dialysis modality decisions 14.…”

Section: Methodsmentioning

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

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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.

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“…Broadly, the topics addressed include a description of the disease and the treatment options, ways of managing the disease and practical suggestions (from transport to advanced health care directives) (Isnard Bagnis et al . ; Da Silva‐Gane et al . ).…”

Section: Individualising Rrtoementioning

confidence: 99%

“…To help address this need, the current authors composed a consensus statement intended to give more detailed and practical guidance to health care practitioners (HCPs) on how to approach every stage of RRTOE (Isnard Bagnis et al . ). The purpose of the current paper is to tailor this guidance to nurses and to provide advice on how to individualise RRTOE according to best practices.…”

Section: Introductionmentioning

confidence: 97%

Continuing Education: Preparing Patients to Choose a Renal Replacement Therapy

Goovaerts

Isnard

Crepaldi

et al. 2015

Journal of Renal Care

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SUMMARY Background Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines Objectives To provide nurses with advice and guidance on running RRTOE. Design A consensus conference. Participants Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. Approach Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. Results Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. Conclusions Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. Application to Practice There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal – providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.

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Quality standards for predialysis education: results from a consensus conference

Cited by 33 publications

References 29 publications

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

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

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

Continuing Education: Preparing Patients to Choose a Renal Replacement Therapy

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