Implementation and effectiveness of an intensive education program on phosphate control among hemodialysis patients: a non-randomized, single-arm, single-center trial

Family-centered empowerment approach to optimize phosphate management among hemodialysis patients: an experimental study

BACKGROUND

This study aimed to investigate the effect of a family-centered empowerment program on hyperphosphatemia management.

METHOD

This experimental study was performed on 80 randomly selected eligible patients with hyperphosphatemia undergoing hemodialysis. Patients were assigned randomly to two groups of family-centered empowerment program (FCEPG) and control group (CG) by coin toss (40 people per group). Data collection tools were the researcher-made Phosphate Control Knowledge Scale, the researcher-made Adherence to Dietary Restriction of Phosphorus Intake Scale, the eight-item Morisky Medication Adherence Scale, and serum phosphorus measurements. Data were collected before the intervention, one month, and three months after the intervention. Patients in FCEPG participated in a family-centered empowerment program. The statistical significance level was considered to be 0.05.

RESULTS

Inter-group comparisons showed no significant difference between FCEPG and CG in terms of the mean score of knowledge of phosphate control, adherence to dietary restriction of phosphorus intake, adherence to medication, and the mean serum phosphorus level before the empowerment program, but showed significant differences between them in these respects at one month after the program and three months after the program (p < 0.05). Intra-group comparisons showed a significant difference in FCEPG between the mean and standard deviation of all four variables before the empowerment program and the corresponding values one month and three months after the program (P < 0.05).

CONCLUSION

The findings of this study can be used in various fields of healthcare in the hospital and community.

Effect of Self-Determination Theory on Knowledge, Treatment Adherence, and Self-Management of Patients with Maintenance Hemodialysis

Our aim of this study was to investigate the effect of self-determination theory on awareness of relevant knowledge, treatment compliance, and self-management level in maintenance hemodialysis (MHD) patients. A total of 90 patients who received MHD treatment in our hospital from April 2018 to June 2020 were selected and randomly divided into the intervention group and the routine group with 45 cases in each group. Both groups were given basic hemodialysis patient management measures, and the intervention group was given self-determination theory to manage patients on this basis. The awareness rate of hemodialysis patient-related knowledge, patient treatment compliance, patient self-management scores, and quality of life scores were compared between the two groups before intervention and 6 months after intervention. After intervention, the awareness rate of dialysis principle, reasonable diet, internal fistula protection, and complication prevention knowledge in the intervention group was higher t (P < 0.05); before intervention, there was no significant difference in the scores of all dimensions of compliance between the two groups (P > 0.05); after intervention, the dietary compliance, fluid intake compliance, dialysis regimen compliance, and total score of compliance in the intervention group were higher than those in the conventional group (P < 0.05). After intervention, the total scores of problem solving, partnership, emotional processing, self-care activities, and self-management in the intervention group were higher than those in the conventional group, (P < 0.05). After intervention, the physical domain, psychological domain, social relationship domain, and total scores of quality of life in the intervention group were higher than those in the conventional group (P < 0.05). Self-determination theory management is effective in improving the awareness of hemodialysis-related knowledge, treatment compliance, self-management level, and quality of life in MHD patients.

A Survey Study on Soy Food Consumption in Patients with Chronic Kidney Diseases

Chronic kidney disease (CKD) is one of the major and exacerbating global health burdens, which is characterized by no curative treatments and high morbidity and mortality. Since malnutrition has become an important factor determining the final clinical outcomes of CKD, soy products, high-quality plant-based sources of proteins and other nutrients, are recommended by many physicians for CKD patients. However, it has been reported that adherence to this dietary advice among those patients is low. In order to dissect the potential reasons behind this phenomenon and to subsequently develop target intervention to improve the current situation, we designed and conducted a self-administered questionnaire survey in 3 medical centers in China. Total 570 patients responded to our survey and data analysis reveals that 85.6% of the respondents were aware of the necessaries of high-quality protein diets for CKD patients, but only 41.9% of patients knew that soy foods provide high-quality proteins needed. In contrast, up to 90.4% of patients were affected by the notion that patients with CKD should avoid soy products. Besides, comparing with other groups, higher percentage of patients undergoing peritoneal dialysis recognized soy products as foods with high-quality proteins, however, as many as 68.8% of them did not consume any soy foods due to the concerns of adverse effects on the progress of CKD. Our data suggest that a significant portion of patients with CKD do not consume soy foods, which could be mainly resulted from their misconception towards soy products delivered by medical workers or social media. Evidence-based updated education of patients and medical workers on soy foods would be a necessary strategy for improving nutrition status of CKD patients and their clinical outcomes.