The effect of structured education and treatment decision support on patient outcomes in urgent start chronic dialysis patients

The research is conducted as a controlled and experimental study to develop and apply the ''Dialysis Training Program and Decision Tree'' that will support kidney patients who have indications for dialysis and initiated chronic dialysis treatment in emergency conditions, to choose the renal replacement therapy option, that most suits their life styles, as well as to evaluate the effect of this practice on treatment satisfaction, treatment compliance, self-care, quality of life, depression and patient laboatory and clinical results. Research conducted in two hospital, (Training and Research Hospital and Private Foundation Hospital). The patients, who have started urgent renal replacement treatment, who have completed 2 or 3 hemodialysis sessions, whose clinical condition is stable, were randomized as Dialysis Training Program (DEP; n=43) group and Decision Tree Supported Training Program (KADEP; n=43) group by using the simple random sampling method. The study was approved by the ethics committee and written informed consent was obtained from the patients. Prior to develop the decision tree with DEP curriculum and training tools, needs analysis was conducted in two phases. First Phase; Focus group discussion with the patients (n=14) and Second Phase; Survey with the health care professionals (n=104). DEP and Decision Tree was developed in line with the focus group and survey data analysis. Training was provided to the both groups by using DEP curriculum and training tools in 2 interviews. Decision Tree application was carried out in the additional 3rd interview with the patients in the KADEP group. Before and 3 months after the training; data was collected by means of Demographical and Clinical Data Form, Patient Assessment of Chronic Illness Care-Patient Form, Self-Care Ability of Chronic Dialysis Patients Assessment Scale, General Quality of Life Scale (EQ-5D-5L) and Patient Health Survey (PHQ-9). Biochemical values (urea, creatinine, albumin, total protein, hemoglobin, hematocrit, calcium, phosphor, KT/V, residual urine, CRP), blood pressure and body weight were measured. The data was analyzed on SPSS (v24) program by using descriptive statistics, t test in dependent and independent groups and Mann Whitney U and Wilcoxon signed rank tests. The level of significant was recognized as p<05. Before the intervention, there were no differences among the two groups in terms of the demographical and clinical characteristics and biochemical results (p>0.05) and the groups were homogenous. After the intervention, it was observed that the laboratory and clinical values were better in the KADEP group, on which training and decision tree was applied, as compared to the DEP group, treatment compliance and satisfaction has increased, patients better managed the chronic disease and self-care, quality of life has increased and the frequency of depression has decreased (p<0.001). The data acquired indicates that providing training and decision support to the patients that start dialysis treatment in emergency conditions is more efficient than only training. It could be suggest that the KADEP that has been developed in this study could be used for the similar patient groups.