Educational Interventions in Kidney Disease Care: A Systematic Review of Randomized Trials
Received 12 September 2007; accepted 31 January 2008. published online 28 April 2008.
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.
Address correspondence to Jo Mason, MA(Hons), Ward 15 (Research Offices), Leicester General Hospital, University Hospitals of Leicester, NHS Trust, Gwendolen Rd, Leicester, LE5 4PW, UK.
ABSTRACT