Laura Lunardi

BACKGROUND: Chronic kidney disease (CKD) is a complex health condition that profoundly impacts an individual's general health and well-being throughout their entire lifetime. People with CKD require the knowledge, confidence, and skills to actively self-manage their health. This is referred to as patient activation. The efficacy of interventions to increase patient activation in the CKD population is unclear. AIM: This study aimed to examine the effectiveness of patient activation interventions on behavioral health-related outcomes among people with CKD stages 3-5. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with CKD stages 3-5 was performed. MEDLINE, EMCARE, EMBASE, and PsychINFO databases were searched between 2005 and February 2021. Risk of bias was assessed using the Joanna Bridge Institute critical appraisal tool. RESULTS: Nineteen RCTs that enrolled 4414 participants were included for synthesis. Only one RCT reported patient activation using the validated 13-item patient activation measure (PAM-13). Four studies demonstrated strong evidence that the intervention group developed a higher level of self-management compared to the control group (standardized mean differences [SMD] = 1.12, 95% CI [0.36, 1.87], p = .004). Eight RCTs led to a significant improvement in self-efficacy (SMD = 0.73, 95% CI [0.39, 1.06], p < .0001). There was weak to no evidence on the effect of the strategies shown on the physical component and mental components of health-related quality of life, and medication adherence. LINKING EVIDENCE TO ACTION: This meta-analysis highlights the importance of including tailored interventions using a cluster approach including patient education, goal setting with individualized action plan, and problem-solving to engage patients to be more actively involved in the self-management of their CKD.

BACKGROUND: Identification of people with deteriorating health is essential for quality patient-centred care and optimal management. The Supportive and Palliative Care Indicators Tool (SPICT) is a guide to identifying people with deteriorating health for care planning without incorporating a prognostic time frame. OBJECTIVES: To improve renal nursing staff confidence in identifying patients approaching end-of-life and advocate for appropriate multidisciplinary care planning. DESIGN: This pilot feasibility prospective cohort study conducted in the renal ward of a major metropolitan health service during 2019 included a preintervention/postintervention survey questionnaire. A programme of education was implemented training staff to recognise end-of-life and facilitate appropriate care planning. RESULTS: Several domains in the postintervention survey demonstrated a statistically significant improvement in renal nurses' perception of confidence in their ability to recognise end of life. Of the 210 patients admitted during the study period, 16% were recognised as SPICT positive triggering renal physicians to initiate discussions about end-of-life care planning with patients and their families and to document a plan. Six months poststudy, 72% of those patients recognised as SPICT positive had died with a documented plan of care in place. CONCLUSION: The use of SPICT for hospital admissions and the application of education in topics related to end-of-life care resulted in a significant improvement in nurses' confidence in recognising deteriorating and frail patients approaching their end of life. The use of this tool also increased the number of deteriorating patients approaching end of life with goals of care documented.

BACKGROUND: Patient activation refers to the knowledge, confidence and skills required for the management of chronic disease and is antecedent to self-management. Greater self-management in chronic kidney disease (CKD) results in improved patient experience and patient outcomes. AIM: To examine patient activation levels in people with CKD stage 5 pre-dialysis and determine associations with sociodemographic characteristics, treatment adherence and healthcare utilisation. METHODS/DESIGN: People with CKD stage 5 not receiving dialysis from one Australian kidney care service. Patient activation was measured using the 13-item Patient Activation Measure (PAM-13). Sociodemographic and clinical outcome data (emergency department visits, admissions) were collected from medical records. Morisky Medication Adherence Scale was used to determine self-report medication adherence. RESULTS: Two hundred and four participants completed the study. The mean PAM-13 score was 53.4 (SD 13.8), with 73% reporting low activation levels (1 and 2). Patient activation scores significantly decreased with increased age (P < 0.001) and significantly increased with higher educational levels (P < 0.001). Higher patient activation level was associated with fewer hospital emergency department visits (P = 0.03) and increased medication adherence (P < 0.001). CONCLUSION: Patient activation levels are low in people with CKD stage 5 not receiving dialysis suggesting limited ability for self-management and capacity for optimally informed decisions about their healthcare. Efforts to improve patient activation need to consider age and education level.

The Renal Society of Australasia Journal is the official Renal Society and peak Australasian scholarly journal for nephrology nurses and associated professionals to share their ideas and research to promote evidence-based, high quality care for persons living with renal disease.

OBJECTIVE: This review aims to examine the effect of patient activation interventions compared with usual care on health-related behavioral outcomes in adults with chronic kidney disease stages 3-5. INTRODUCTION: Chronic kidney disease is a global health problem associated with a high mortality, reduction of health-related quality of life, and high health care costs. The chronic nature requires active involvement and self-management of the person with chronic kidney disease. Patient activation is a self-management approach that refers to the knowledge, confidence, and skills of people to enable them to manage their own health needs. However, the effectiveness of patient activation interventions on health-related behavioral outcomes in this population have not yet been systematically evaluated. INCLUSION CRITERIA: This systematic review will include primary research studies measuring the effect of behavioral change interventions addressing beliefs, knowledge, confidence, and/or skills to optimize self-management in adult patients with chronic kidney disease stages 3-5 who are not receiving dialysis. Studies included in this review will be randomized controlled trials. METHODS: Published studies will be searched in MEDLINE, Embase, Emcare, and PsycINFO. Unpublished studies and gray literature sources will also be searched. Titles and abstracts of search results published in English from 2005 onward will be screened, and the full text of potentially relevant studies will be assessed in detail. Studies selected for inclusion will undergo critical appraisal. Data extracted will include specific details about population, study methods, interventions, and outcomes. Studies will be pooled in statistical meta-analysis, if possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020205084.