Dubin Ruth, Rubinsky Anna
San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States.
University California San Francisco, San Francisco, CA, United States.
JMIR Form Res. 2019 Feb 6;3(1):e12528. doi: 10.2196/12528.
Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies.
This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options.
We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care.
Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001).
Implementation of a digital ESRD education program is feasible and may facilitate patients' decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes.
ClinicalTrials.gov NCT02976220; https://clinicaltrials.gov/ct2/show/NCT02976220.
针对终末期肾病（ESRD）的患者教育有潜力减少不良结局，并增加家庭肾脏替代疗法的使用。
本研究旨在调查一个在线的、易于扩展的教育项目是否能提高患者知识水平，并促进其在肾脏替代治疗方案方面的决策。
我们开发了一个为期4周的在线数字教育项目，其中包括书面信息、短视频和社交网络功能。主题包括肾移植、保守治疗、腹膜透析、家庭血液透析和中心血液透析。我们招募了晚期慢性肾病（IV期和V期）患者参加该在线项目，并通过在知识、自我效能和ESRD护理选择等方面进行干预前和干预后的调查，评估该数字项目的可行性和潜在影响。
在98名符合研究条件的个体中，28名登记并签署了知情同意书，25名完成了研究。参与者的平均年龄为65（标准差15）岁，平均估计肾小球滤过率为21（标准差6）ml/min/1.73m²。干预前，32%的患者（共8/25）无法做出ESRD治疗选择；干预后，所有25名参与者都做出了选择。选择肾移植作为首选的人数比例从入组时的48%（12/25）增加到项目完成后的84%（21/25）（P=0.01）。在透析方式选项中，选择腹膜透析作为首选的患者比例从入组时的4/25（16%）增加到项目完成后的13/25（52%）（P=0.004）。我们还观察到知识得分（从65[标准差56]提高到83[标准差14]；P<0.001）和自我效能得分（从3.7[标准差0.7]提高到4.3[标准差0.5]；P<0.001）有显著提高。
实施数字ESRD教育项目是可行的，并且可能有助于患者在肾脏替代治疗方面做出决策。需要进行更大规模的研究来了解该项目是否会影响临床结局。
ClinicalTrials.gov NCT02976220；https://clinicaltrials.gov/ct2/show/NCT02976220 。
