Educational interventions in kidney disease care: a systematic review of randomized trials.

BACKGROUND: There is increasing evidence that educational interventions aimed at empowering patients are successful in chronic disease management. Our aim was to conduct a systematic review of the effectiveness of such educational interventions in people with kidney disease. SYSTEMATIC REVIEW: A comprehensive search strategy was applied by using major electronic databases from 1980 to March 2007. Researchers independently reviewed titles and abstracts and extracted data from identified studies. SETTING & POPULATION: Patients in any of the following stages of chronic kidney disease: early, predialysis, and dialysis. Kidney transplant recipients were excluded because this group has additional educational needs that are beyond the scope of this review. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials. INTERVENTIONS: Structured educational interventions (involving informational and psychological components) with usual care. OUTCOMES: Clinical, behavioral, psychological, and knowledge outcomes were considered. RESULTS: 22 studies were identified involving a wide range of multicomponent interventions with variable aims and outcomes depending on the area of kidney disease care. 18 studies provided significant results for at least 1 of the outcomes. The majority of studies aimed to improve diet and/or fluid concordance in dialysis patients and involved short- and medium-term follow-up. A single major long-term study was a 20-year follow-up of a predialysis educational intervention that showed increased survival rates. No study was found that addressed chronic kidney disease at an earlier stage. LIMITATIONS: Meta-analysis was not possible because of study heterogeneity. CONCLUSIONS: Multicomponent structured educational interventions were effective in predialysis and dialysis care, but the quality of many studies was suboptimal. Effective frameworks to develop, implement, and evaluate educational interventions are required, especially those that target patients with early stages of chronic kidney disease. This could lead to possible prevention or delay in progression of kidney disease.

Educational needs for blood pressure control in chronic kidney disease.

Strict blood pressure control reduces the risk of adverse outcomes in chronic kidney disease but is difficult to achieve. To inform the design of an educational intervention for patients with chronic kidney disease and hypertension, we used focus groups to identify key patient issues, from both patient and healthcare professional perspectives. Framework methodology was used to analyse data and patient confusion emerged as the core concept. This was both an effect and, in some cases, a cause of the six key themes identified: lack of basic knowledge; conflicting advice; nature of diagnosis; changes in evidence-based practice; views on patient empowerment and views on the patient-health professional relationship. Educational needs identified involved addressing confusion by increasing both knowledge and motivation. In people with chronic kidney disease, confusion can lead to a lack of motivation and negative views that need to be addressed through appropriate education and support.