In my opinion, patient education plays a vital role in planning for dialysis options in end-stage kidney disease (ESKD). It involves more than just having a 5-minute discussion during an office visit or providing patients with handouts. It requires an in-depth discussion about what the different dialysis options are, how patients can manage their symptoms, what patients can do to improve their outcomes, and how they can be engaged in their healthcare. Patients who are progressing to ESKD and looking at dialysis or conservative care are vulnerable to numerous complications of their disease and poor outcomes can occur.
In Wang’s article, they examine the impact of a MDPC on the risks of post-dialysis peritonitis, technique failure and mortality in peritoneal dialysis (PD) patients at a tertiary medical center in Taiwan. The MDPC team consisted of nephrologists, dietitians and nurses. They provided standardized pre-dialysis education according to the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines. They did not demonstrate any significance between the MDPC group and non-MDPC group in rates for development of the first episode of peritonitis, technique failure, or mortality. But PD patients with diabetes, who received MDPC, were found to have a lower risk of mortality.
The impact of pre-dialysis education has been studied by other groups. Chou et al. found that pre-ESKD care education for those with CKD stage G3-5 was associated with improved patient outcomes, including the incidence of hemodialysis and hospitalization events and a higher overall survival rate. Koch-Weser et al. examined multiple patient education practices on content and accessibility or whether they support shared-decision making for patients with advanced chronic kidney disease. The study highlighted the great variability in education delivery, follow-up, and outcomes reported. Additionally, the education programs were not consistently following best practices related to health literacy or supporting shared-decision making.
Nephrology guidelines, such as Kidney Disease: Improving Global Outcomes (KDIGO) and Kidney Disease Outcomes Quality Initiative (KDOQI), recommend education for patients but there is no guidance on the format or structure of how to provide this education. There is probably not a single optimal format and providers will need to gauge the learning styles of patients and tailor programs. The study by Wang et al. brings up two areas that are worth studying further. First, the long-term impact of pre-dialysis education on mortality benefits continued post-dialysis initiation. Second, those factors specifically related to the dialysis procedure may not be retained long-term and perhaps ensuring there is a multidisciplinary approach to training would be important to reinforce this additional knowledge.
As long as education is provided to patients, I do not believe there is a specific format needed. A program should offer many forms of education since adult patients have different learning styles. Furthermore, ensuring that the same level of education is provided not only in pre-dialysis education but also once a patient has started dialysis.
What are you doing to educate your patients?