P16
DOES SELF-MANAGEMENT SUPPORT IN HAEMODIALYSIS PATIENTS
IMPROVE CLINICAL AND PSYCHOLOGICAL OUTCOMES? A NARRATIVE
REVIEW
Reston, J¹, Farrington, K², Wellsted, D1, Wilson, P3, Bieraugel, R2, Offredy, M3, Da SilvaGane, M2
¹Centre for Lifespan and Chronic Illness Research, University of Hertfordshire, ²Lister
Hospital, East & North Hertfordshire NHS Trust, 3Centre for Research in Primary and
Community Care, University of Hertfordshire
BACKGROUND: Haemodialysis (HD) patients are burdened with a great deal of treatment
demands. While clinical input is essential to treatment, much of the variation in patient
outcomes is due to how well the patients manage their own illness (dialysis adherence,
medication and dietary/fluid adherence, exercise, care of access site etc). A wealth of research
demonstrates that simply educating dialysis patients about their disease with technical
information will not have a significant impact on their treatment outcomes. There is promising
research in other chronic diseases that suggests that focusing on enhancing patients’ abilities to
self-manage, partially through enhancing their self-efficacy (confidence in their abilities to bring
about desired outcomes through their own agency), has a much greater impact. There is
comparatively little work on the subject in renal patients. This review aims to summarize the
literature on self-management in chronic diseases, and to evaluate such interventions’ potential
usefulness in HD patients in light of existing work. The aim of this review was to provide the
knowledge base for a National Institute for Health Research (NIHR) funded programme of work
looking at implementing such an intervention for renal patients.
REVIEW TYPE/METHODS: The review takes a narrative structure, dealing chronologically
with the evidence from other chronic diseases, before addressing the existing work in dialysis
patients (all modalities, with a focus on HD). Papers were systematically identified using
Pubmed, the Cochrane Library, Google Scholar, journal searches and hand searching.
FINDINGS: The review is based on approximately 120 papers on self-management in chronic
disease. The majority of original papers describing the trial of some form of intervention were
found to have beneficial effects on a variety of clinical and psychological outcomes. The
greatest beneficial impact was found for diabetes patients. Given the prevalence of diabetes
among dialysis patients (44% of HD patients), lessons useful to nephrology clinics are outlined.
Much of the work on self-management in dialysis patients is ongoing, including three studies in
the NHS. The rate of papers published on the subject has increased in recent years, but quality
of reporting is a frequent problem. Successful interventions to date have frequently been nurseled, and have been those based on collaboration between the entire MDT.
CONCLUSION: Self-management education has been shown to improve clinical and
psychological outcomes in other disease groups. Some published work with dialysis patients
indicates a benefit in this population, but further exploration of the ‘active ingredients’ is
required. Furthermore, most of the work has been carried out in the US, where dialysis centres
operate in a very different manner, and where supporting patients in managing their finances
forms a core aspect of self-management. Thus to ensure relevance to the NHS, UK based
studies that explore realistic methods of implementation are required.
RELEVANCE: Improving the quality and length of life for patients with End Stage Renal
Failure requiring dialysis requires collaboration and effort from both the Multidisciplinary
Team, and the patients in their care. This review provides an overview of where the academic
literature on self-management currently stands in relation dialysis patients. Multidisciplinary
involvement in self-management education is found to be important to patient outcomes.