Thursday, 8 July 2010

Education, education, education

Opportunities for patient education exist at all key stages of kidney care, from time of diagnosis with early CKD to end stage renal failure; and education remains as important now as when Tony Blair made it his Government’s key priority in his Conference Speech in 1997.

Successful contemporary educational interventions for people with a chronic disease typically incorporate information, components to improve knowledge along with a variety of psychological methods to empower patients and change behaviour. Knowledge is a pre-condition for change. If people lack knowledge about how their lifestyle habits affect their health they have little reason to change behaviour. Behavioural change requires people to develop the means to exercise control over their motivation and health habits. Such interventions have produced clinically important benefits in the areas of diabetes and hypertension.

It was with this in mind that I went to the Renal Education Network meeting in Coventry on 23 June. It clashed with the Slovenia v England game which we missed – but the less said about the World Cup the better. The meeting brought together about 100 people interested in patient education and behavioural change. There were a mixture of plenary talks to set the scene, poster presentations mainly covering ongoing local work – they were excellent – and interactive workshops to share knowledge and expertise to answer

1. how do we deliver education to patients
2. how do we empower patients
3. how do we educate the educators
4. how do we evaluate the effects of what we have done

Dr Jo Burn (Nurse Research Fellow) spoke about her work in Leicester where the team have looked at all the kidney literature in detail and found 22 studies involving a wide range of multi-component interventions with variable aims and outcomes depending on the area of kidney disease care. A single major long term study was a 20 year follow up of pre-dialysis education intervention that showed increased survival rates but the quality of many of the other studies was sub-optimal. No study was found that addressed chronic kidney disease at an earlier stage.

Jo concluded that some educational interventions were successful at improving clinical, behavioural and psychological knowledge outcomes in pre-dialysis and dialysis patients and warrant further investigation. However, the main plea was for the development of a general framework to improve design, delivery and evaluation of educational interventions. Such frameworks already exist for complex interventions and diabetes education; and that’s where Kate McCarthy and Rob Higgins (both at Coventry & Warwickshire NHS Trust) and the Renal Education Network might step in. Rob and Kate aim to produce a discussion paper for publication based on the ideas and conclusions drawn from the workshops.

Poster Presentations

Poster 1 - Neerja Jain, Kidney Research UK: Development of an educational intervention for people with early chronic kidney disease who are managed in primary care.

Poster 2 - Rakesh Patel , University Hospitals of Leicester NHS Trust: Early fistula placement and information from different professionals doesn’t make a difference to quality of life reported by patients... could better education?

Poster 3 - Dr Alice Smith, University of Leicester: Physical activity in advanced chronic kidney disease: why we should educate our patients to exercise.

Poster 4 - Deborah Douglas, Gwyn Somers, Sheffield Teaching Hospitals NHS Foundation Trust: Developing a pathway for the education of unplanned start dialysis patients.

Poster 5 - Chris Williams, Sue Heatley, City of Manchester Foundation Trust: A novel approach to educating pre-dialysis patients and carers ‘Harry meets Sally’

Poster 6 - Kate McCarthy, University Hospitals Coventry & Warwickshire NHS Trust: Pre-dialysis education: A patient s’ needs assessment.

Poster 7 - Chris Williams, Sue Heatley, City of Manchester Foundation Trust: Developing a model for self-care in pre-dialysis.

Poster 8 - Michelle Clemenger, Imperial College Healthcare NHS Trust: The renal adaptation program: An educational support programme for patients who present as “crashlanders”.