Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston.
Department of Occupational Therapy, Tufts University, Medford, Massachusetts.
Am J Kidney Dis. 2021 Nov;78(5):690-699. doi: 10.1053/j.ajkd.2021.02.334. Epub 2021 Apr 22.
RATIONALE & OBJECTIVE: Education programs are needed for people with advanced chronic kidney disease to understand kidney failure treatment options and participate in shared decision-making (SDM). Little is known about the content and accessibility of current education programs or whether they support SDM.
Stakeholder-engaged, mixed-methods design incorporating qualitative observations and interviews, and a quantitative content analysis of slide presentations.
SETTING & PARTICIPANTS: Four sites located in Boston, Chicago, Portland (Maine), and San Diego.
Thematic analysis based on the Ottawa Framework (observations and interviews) and descriptive statistical analysis (slide presentations).
Data were collected from observations of 9 education sessions, 5 semistructured interviews with educators, and 133 educational slide presentations. Sites offered group classes or one-on-one sessions. Development, quality, and accuracy of educational materials varied widely. Educators emphasized dialysis (often in-center hemodialysis), with little mention of conservative management. Educators reported patients were often referred too late to education sessions and that some patients become overwhelmed if they learn of the implications of kidney failure in a group setting. Commonly, sessions were general and did not provide opportunities for tailored information most supportive of SDM. Few nephrologists were involved in education sessions or aware of the educational content. Content gaps included prognosis, decision support, mental health and cognition, advance care planning, cost, and diet. Slide presentations used did not consistently reflect best practices related to health literacy.
Findings may not be broadly generalizable.
Education sessions focused on kidney failure treatment options do not consistently follow best practices related to health literacy or for supporting SDM. To facilitate SDM, the establishment of expectations for kidney failure treatment options should be clearly defined and integrated into the clinical workflow. Addressing content gaps, health literacy, and communication with nephrologists is necessary to improve patient education in the setting of advanced chronic kidney disease.
需要为患有晚期慢性肾脏病的人群提供教育计划，以了解肾衰竭治疗方案并参与共同决策（SDM）。目前尚不清楚现有的教育计划的内容和可及性，或者它们是否支持 SDM。
这是一项由利益相关者参与的混合方法设计，纳入了定性观察和访谈，以及幻灯片演示的定量内容分析。
四个地点分别位于波士顿、芝加哥、波特兰（缅因州）和圣地亚哥。
基于渥太华框架的主题分析（观察和访谈）和描述性统计分析（幻灯片演示）。
从 9 次教育课程的观察、5 次与教育者的半结构访谈以及 133 份教育幻灯片演示中收集了数据。各站点提供小组课程或一对一课程。教育材料的开发、质量和准确性差异很大。教育者强调透析（通常是中心血液透析），很少提及保守治疗。教育者报告说，患者通常被转诊到教育课程太晚，如果在小组环境中了解到肾衰竭的影响，一些患者会感到不知所措。通常，课程内容较为笼统，没有提供最有利于 SDM 的个性化信息机会。很少有肾病医生参与教育课程或了解教育内容。内容差距包括预后、决策支持、心理健康和认知、预先护理计划、成本和饮食。使用的幻灯片演示没有始终如一地反映与健康素养相关的最佳实践。
研究结果可能无法广泛推广。
聚焦于肾衰竭治疗方案的教育课程并没有始终遵循与健康素养或支持 SDM 相关的最佳实践。为了促进 SDM，应该明确规定对肾衰竭治疗方案的期望，并将其纳入临床工作流程。为了提高晚期慢性肾脏病患者的教育水平，需要解决内容差距、健康素养以及与肾病医生的沟通问题。
