Patient Education and Peritoneal Dialysis Modality Selection: A Systematic Review and Meta-analysis

Abstract

Background: Educational interventions are increasingly used to promote peritoneal dialysis (PD), the most common form of home therapy for end-stage renal disease. A systematic review of the evidence in support of dialysis modality education is needed to inform the design of patient-targeted interventions to increase selection of PD. We performed a systematic review and meta-analysis to characterize the relationship between patient-targeted educational interventions and choosing and receiving PD.

Study design: Systematic review and meta-analysis.

Setting & population: Published original studies and abstracts.

Selection criteria for studies: We searched MEDLINE, EMBASE, CINAHL and EBMR. We included controlled observational studies and randomized trials of educational interventions designed to increase PD selection.

Intervention: Predialysis educational interventions.

Outcomes: The primary outcome was choosing PD, defined as intention to use PD regardless of whether PD was ever used. The secondary outcome, receiving PD, was defined as an individual receiving PD as his or her treatment.

Results: Of 3,540 citations, 15 studies met our inclusion criteria, including 1 randomized trial. In the single randomized trial (N=70), receipt of an educational intervention was associated with a more than 4-fold increase in the odds of choosing PD (OR, 4.60; 95% CI, 1.19-17.74). Based on results from 4 observational studies (N=7,653), patient-targeted educational interventions were associated with a 2-fold increase in the odds of choosing PD (pooled OR, 2.15; 95% CI, 1.07-4.32; I(2)=76.7%). Based on results from 9 observational studies (N=8,229), patient-targeted educational intervention was associated with a 3-fold increase in the odds of receiving PD as the initial treatment modality (OR, 3.50; 95% CI, 2.82-4.35; I(2)=24.9%).

Limitations: Most studies were observational studies, which can establish an association between education and choosing PD or receiving PD, but does not establish causality.

Conclusions: This systematic review demonstrates a strong association between patient-targeted education interventions and the subsequent choice and receipt of PD.

Keywords: Peritoneal dialysis (PD); choosing PD; dialysis modality; end-stage renal disease (ESRD); medical decision-making; modality selection; patient choice; patient-centered care; patient-targeted educational intervention; renal replacement therapy (RRT); systematic review.