van Ek Gaby F, Krouwel Esmée M, Nicolai Melianthe P J, Den Oudsten Brenda L, Den Ouden Marjolein E M, Dieben Sandra W M, Putter Hein, Pelger Rob C M, Elzevier Henk W
Department of Urology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Medical and Clinical Psychology and Centre of Research on Psychological and Somatic Disorders, Tilburg University, Tilburg, The Netherlands.
Int Urol Nephrol. 2017 Jul;49(7):1273-1285. doi: 10.1007/s11255-017-1577-z. Epub 2017 Mar 29.
This study evaluated current fertility care for CKD patients by assessing the perspectives of nephrologists and nurses in the dialysis department.
Two different surveys were distributed for this cross-sectional study among Dutch nephrologists (N = 312) and dialysis nurses (N = 1211).
Response rates were 50.9% (nephrologists) and 45.4% (nurses). Guidelines on fertility care were present in the departments of 9.0% of the nephrologists and 15.6% of the nurses. 61.7% of the nephrologists and 23.6% of the nurses informed ≥50% of their patients on potential changes in fertility due to a decline in renal function. Fertility subjects discussed by nephrologists included "wish to have children" (91.2%), "risk of pregnancy for patients' health" (85.8%), and "inheritance of the disease" (81.4%). Barriers withholding nurses from discussing FD were based on "the age of the patient" (62.6%), "insufficient training" (55.2%), and "language and ethnicity" (51.6%). 29.2% of the nurses felt competent in discussing fertility, 8.3% had sufficient knowledge about fertility, and 75.7% needed to expand their knowledge. More knowledge and competence were associated with providing fertility health care (p < 0.01).
In most nephrology departments, the guidelines to appoint which care provider should provide fertility care to CKD patients are absent. Fertility counseling is routinely provided by most nephrologists, nurses often skip this part of care mainly due to insufficiencies in self-imposed competence and knowledge and barriers based on cultural diversity. The outcomes identified a need for fertility guidelines in the nephrology department and training and education for nurses on providing fertility care.
本研究通过评估透析科室肾科医生和护士的观点，来评价目前对慢性肾脏病（CKD）患者的生育护理情况。
针对这项横断面研究，向荷兰的肾科医生（N = 312）和透析护士（N = 1211）发放了两份不同的调查问卷。
肾科医生的回复率为50.9%，护士的回复率为45.4%。9.0%的肾科医生所在科室和15.6%的护士所在科室有生育护理指南。61.7%的肾科医生和23.6%的护士向≥50%的患者告知了肾功能下降导致生育能力潜在变化的情况。肾科医生讨论的生育相关主题包括“想要孩子”（91.2%）、“妊娠对患者健康的风险”（85.8%）以及“疾病遗传”（81.4%）。阻碍护士讨论生育问题的因素包括“患者年龄”（62.6%）、“培训不足”（55.2%）以及“语言和种族”（51.6%）。29.2%的护士认为自己有能力讨论生育问题，8.3%的护士对生育有足够的了解，75.7%的护士需要扩充知识。更多的知识和能力与提供生育健康护理相关（p < 0.01）。
在大多数肾病科室，缺乏指定应由哪位护理人员为CKD患者提供生育护理的指南。大多数肾科医生会常规提供生育咨询，而护士往往跳过这部分护理，主要原因是自我认定的能力和知识不足以及文化多样性带来的障碍。研究结果表明肾病科室需要生育指南，以及对护士进行提供生育护理方面的培训和教育。
