P180
EQUIPPING
PATIENTS
FOR
PRE-DIALYSIS
TREATMENT
CHOICES:
AN EXPLORATION OF THE INFLUENCES IMPACTING ON INDIVIDUALS’ DECISIONMAKING
McCarthy, K
Renal Research Team, University Hospitals Coventry & Warwickshire NHS Trust
INTRODUCTION: Dialysis treatments in chronic kidney disease have clinical equipoise although
very different lifestyle impacts for patients and NHS cost implications. The aim of the study was to
explore the impact and influence of pre-dialysis education on individuals’ treatment decision-making.
METHODS: This was a mixed methods study utilising the first two phases of the MRC (2000)
Complex Intervention Framework. A literature review and a patient needs assessment study informed
the Pre-Clinical Phase I. The Phase II Modelling involved the development of a self-efficacy theory
based pre-dialysis educational intervention; developed through Participant Action Research.
Grounded theory analysis of 54 unstructured interviews, with 20 individuals, was conducted over the
course of individuals’ pre-dialysis journey.
RESULTS: Vicarious experience had the greatest impact on treatment decision-making and influence
was both positive and negative. Early delivery of written information acts as a catalyst for question
development. This has relevance in light of the scale of ill informed and early treatment decisionmaking, identified in this study. CNS’s are central to individuals’ pre-dialysis journey as they provide:
effective education delivery tailored to individual needs; help individuals to negotiate the changes in
primary versus secondary care delivery; and they challenge ill informed treatment decisions.
CONCLUSION: This study has shown that self-efficacy theory provides an effective foundation for
the development and delivery of a complex pre-dialysis educational intervention, tailored to facilitate
informed treatment decision-making. There are a number of practice implications:

The multidisciplinary team and service users should be involved in education development
and delivery.

A core curriculum delivered using a range of educational formats to facilitate the delivery of
tailored education.

Education delivery based on self-efficacy theory.

Trained peer supporters.

Educators need to be trained to deliver self-efficacy enhancing education.

A peer support programme that is available to individuals at all stages of their renal journey,
from diagnosis onwards.