Patient education is a crucial factor in the question of what type of treatment a dialysis patient chooses: This is the result of an international study performed by Diaverum. It was published in the scientific journal PLOS ONE in May 2016. Patients receiving information about the different treatment options in advance of their first dialysis session chose significantly more often peritoneal dialysis (PD), whereas haemodialysis (HD) is chosen by patients who start dialysis without prior information to the treatment – and that, although there is no medical indication against PD.
In 2012, with more than 500 patients from 25 dialysis centers in Poland, Hungary and Romania Diaverum has examined the circumstances, which led to the decision for one of the two treatment forms. It is the first study in Eastern Europe, which examines the relationship between patient education and type of treatment. For the evaluation, a distinction was made whether the start of the dialysis treatment was planned (with more than three months in advance, 42%) or non-scheduled (less than three months, 58%). The result is unambiguous: 98% of non-planned treatments were performed as hemodialysis, only 2% as peritoneal dialysis. Balanced ratio, however, can be seen with the scheduled treatments: Here the patient decided together with their doctors in at least 17% of all cases to use PD, 83% chose HD. The main reason identified by the experts of Diaverum was the information provided to the patients: In 94% of the cases with planned treatment starts , patients received extended patient education sessions and material. In cases with unplanned treatments, this was possible only in 69% of cases.
Willingness to change is low, more patient education needed
The study also shows that the decision for a certain type of treatment is made very early: Only 4.5% of patients with a non-scheduled start of treatment changed later on from hemodialysis to peritoneal dialysis. “The willingness to change is low. Most patients remain with treatment form with which they started, “says Prof. Dr. Belén Marrón, Medical Director Worldwide Home Therapies. That’s why Diaverum puts a lot of effort into comprehensive patient education and shows the patient – if time permits – the specific treatment forms. While in-centre haemodialysis is always performed by experienced nurses and doctors it ties the patient very much to fixed dialysis times. Peritoneal dialysis needs to be performed by the patient himself. Therefore it offers more flexibility and autonomy for the patient. “We do not advise the patient to one or another form of treatment, but we enable them to make a sustainable decision that fits with their personal and medical needs,” says Dr Marrón.