Icon - Teaching treatment options

Teaching treatment options

The journey to home dialysis starts with modality education, which will have a major impact on the type of treatment chosen. developing leaflets, PowerPoints, DVDs and take-home materials can be time consuming. 

In this section we provide information to assist in the teaching of treatment options, with notes on many aspects of pre-dialysis education, together with links to:

  • alternative language tools
  • consolidated fact sheets
  • patient education brochures and DVDs
  • information sheets
  • PowerPoint presentations.

Pre-dialysis education
Surveys we have undertaken show that pre-dialysis education is the most significant process in determining choice of dialysis modality.

The role of pre-dialysis educators is clearly established in most education programmes but time limitations may reduce the impact of this role. Highlighting the importance of education, we found that in 2010 only 54 per cent of surveyed patients chose their current modality. 

A more recent survey of Australian pre-dialysis education services in 2012 shows that the delivery of pre-dialysis education does impact on the rates of home dialysis.

You can download the 2012 pre-dialysis education survey here.

You can download a one-page summary of the survey here.

Influence of health professionals
Patients are influenced by their nephrologists. This is demonstrated by the wide range in uptake of various modalities in different hospitals and even within the practicing group at each site. 

Careful examination of programmes is required in order to obtain objective data to determine whether co-morbidities, patient choice or personal bias influences the uptake of home dialysis. Personal biases and beliefs need to be addressed.

Education referral
An official referral pathway is required to capture patients at a time deemed appropriate by individual dialysis units, and prevent late referrals.

Education timing
Chronic kidney disease stages 2 to 3 – Promote healthy lifestyle with renal failure considerations.
Chronic kidney disease stages 3 to 4 – Promote healthy lifestyle and introduce all options for treatment.
Chronic kidney disease stage 5 – Confirm dialysis choice.

Pre-education regarding modality choice should be provided at stages 4 to 5, or six to twelve months prior to commencing the chosen treatment option.

Program content

  • Education must be delivered to promote patient choice.
  • The educator needs to offer hope and find out about the patient’s priorities and expectations.
  • Patients and family caregivers highly value treatment that enhances survival and can be performed at home.
  • An inevitable part of education is understanding why renal replacement therapy is required, and the consequences of no treatment.
  • The practical aspects, advantages and disadvantages of each option then need discussion with positive marketing for the ideal modality to achieve best outcomes.
  • Costs to the individual for each treatment type should be detailed.
  • Information regarding any incentives provided by the State should be available.
  • More educational hours is linked with home dialysis uptake.
  • Patient narratives do influence treatment decision-making.

Delivery

  • Solo with an individual and their family member/s or carer/s
  • Group as lectures and interactive workshops
  • Using media such as teleconferencing and webinars
  • Utilising a combination of oral, written and demonstration
  • Personal experience through networking or visiting others who are experiencing home dialysis

Networking and the use of human resources are positive outcomes of group education.

Recommended training materials/tools

  • Simple tool for decision-making regarding suitable modality - My Kidneys My Choice
  • Written information regarding normal kidney functions and how peritoneal and haemodialysis replace these
  • Written information regarding transplant and choosing supportive care (no dialysis)
  • DVDs or computer links re the above
  • Models/posters/demo models of dialysis machines and peritoneal dialysis equipment
  • Written materials or computer links for materials that are culturally and linguistically specific
  • Risk assessment tool for home dialysis

All references can be found here.

Modality selection tool
A modality selection tool will assist people with kidney disease in making objective decisions, with the support of health professionals.

The Australian decision-aid ‘My Kidneys, My Choice’ is now available to support patient education and decision making. You can see more information about this decision-aid here.

Pre-dialysis functional assessment tool
A pre-dialysis functional assessment tool is under development by the Hunter New South Wales Health Service. You can see the model here.

If you’d like the development team’s contact details please email homedialysis@kidney.org.au.

Cultural considerations
In a survey to determine cultural appropriateness in chronic disease programmes, only 11 of 273 programmes examined met the benchmarks. Programme and education materials should be assessed for, and aligned with, culturally appropriate resources and communication.

Any message to consider home dialysis must be based on the value and belief system of the individual. If the message cannot be sent and received in English, only interpreters trained in health issues should be used.

We have produced fact sheets in 18 languages, which provide information on the topics ‘Are you at risk?’, ‘Chronic kidney disease’, ‘Nutrition’ and all treatment options.

Useful link
Translations of common dialysis phrases in a range of languages are provided in the Nephrology Resource Guide. On the list of ‘Contents’ choose the ‘Multilingual Communications Guide’. You can download the guide here.

Rural considerations
In rural and remote areas, renal nurses in satellite dialysis units can perform the education role; however, they must be adequately educated in all modalities and have access to the training materials. 

Distance barriers can be overcome by roving educators or teleconferencing. Nurse practitioners conducting remote chronic kidney disease clinics can be a potential model for providing rural education and support.

Fact sheets, brochures and DVDs

Information sheets
Information sheets are available on all the treatment options for end stage kidney disease. The sheets are written in simple language and include photographs. The topics are listed below. You can download any sheet by clicking on the name below.

There are also Indigenous versions of these information sheets.

PowerPoint presentations
A series of PowerPoint presentations are available for you to use when teaching your patients. The topics are listed below.

You can download a PDF of any presentation by clicking on the name, or if you’d like copies of the presentations to adapt please email homedialysis@kidney.org.au.

References
References to information on Home Dialysis presented on this website are all from ‘The Report on Home Dialysis’, which you can download here.

Further enquiries
If you have any queries about teaching treatment options, please phone us on freecall 1800 454 363 or email homedialysis@kidney.org.au.

Home dialysisTeaching peritoneal dialysis (PD)
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