Patient Education for Renal Transplant Recipients
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AbstractBackground: Renal recipients’ knowledge about post-transplant aspects is essential in terms of coping with short-term problems posed by transplantation and the long-term outcome. This requires patient education programs that prepare patients, to the greatest degree possible, for life after returning home with a new kidney.
Aim: The overall aim for this study was to develop knowledge concerning patient education in the context of kidney transplantation. Through a systematic review, the content and effectiveness of patient education interventions for renal recipients were evaluated (paper 1). A questionnaire measuring renal recipients’ knowledge on important post-transplant aspects was developed and the results examined in a cross-sectional study (paper 2). Finally, in a randomized controlled trial, the effect of a structured, tailored patient education program was investigated on renal recipients’ knowledge, compliance, self-efficacy, and quality of life (paper 3).
Method: For the systematic review, 9 controlled clinical trials were included; methodological quality was evaluated according to criteria developed by the Cochrane Musculoskeletal Group. In total, 159 renal recipients participated in the current study. For the descriptive cross-sectional study, renal recipients’ insights into post-transplant aspects were measured 5 days post-transplantation. For the intervention study, 82 participants were randomized into the experimental group and 77 to the control group. The patient education intervention consisted of 5 weekly tailored one-to-one sessions during the first 7 to 8 weeks post-transplantation. The control group received standard care. The primary outcome was measured by the knowledge questionnaire. Secondary outcomes were measured by The General- Self-efficacy (GSE) Scale, the Short Form 12 -Item Health Survey (SF-12), and by estimating the number of patients own graft observations (compliance). A total of 139 participants reached the second measure point (7-8 wk post-tx), and 120 participants reached the third measure point (6 months post-tx).
Results: Nine trials were included in the systematic review. The quality appraisal revealed an overall high risk of bias, indicating a lack of evidence regarding the effects of educational interventions. The mean score of the knowledge questionnaire was 11 (SD, 3, 7) (53% correct answers), ranging from 0 (0.6%) as the lowest score to 19 (0.6%) as the best score out of 19 obtainable points. Lowest scores were given in relation to lifestyle issues (52% correct answers). When investigating the effect of the patient education intervention, higher levels of knowledge and compliance were found in the experimental group at second measure point (p = 0.002 and p = 0.000). At the third measure point, the experimental group reported significantly higher levels of knowledge (0.004), self-efficacy (p = 0.036) and mental score of quality of life (p = 0.001).
Conclusions: As revealed by the knowledge questionnaire, renal recipients seem to be insecure regarding some of the important post-transplant aspects shortly before being discharged from the hospital. Through this thesis, we have shown one way of providing renal transplant recipients with an effective patient education program, with beneficial effects in both short and longer terms. As previous research is limited in the area, the results from this study might provide valuable guidance for clinical practice and future research.
List of papers
|Paper I: Urstad, K. H., Wahl, A. K., Andersen, M. H., Øyen, O., & Hagen, K. B. (2013). Limited evidence for the effectiveness of educational interventions for renal recipients. Results from a systematic review of controlled clinical trials. Patient Education and Counseling, 90(2), 147-154. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1016/j.pec.2012.10.020|
|Paper II: Urstad, K. H., Andersen, M. H., Øyen, O., Moum, T., & Wahl, A. K. (2011). Patients' level of knowledge measured five days after kidney transplantation. Clinical Transplantation, 25(4), 646–652. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1399-0012.2010.01355.x|
|Paper III: Urstad, K.H., Øyen, O., Andersen M.H., Moum T., Wahl A.K. (2012). The effect of an educational intervention for renal recipients: A randomized controlled trial. Clinical Transplantation, 26(3), E246-E253. The paper is removed from the thesis in DUO due to publisher restrictions. The published version is available at: https://doi.org/10.1111/j.1399-0012.2012.01666.x|