JMIR Publications

ABSTRACT

Background:

When chronic kidney disease (CKD) progresses to end-stage kidney disease (ESKD), many patients receive in-center hemodialysis. Although lifesaving, hemodialysis is associated with intradialytic hypotension (IDH), a common complication that can cause distressing symptoms and lead to organ and tissue damage. Peer mentoring and patient activation have supported self-management in other chronic illnesses, but their use to improve hemodialysis session stability has not been well studied.

Objective:

The Dialysafe Study combined patient education and peer mentoring to promote health behaviors supporting hemodialysis session stability. We aimed to describe intervention recruitment, engagement, completion, and attrition; assess participants’ health goals and self-reported behavior changes; and evaluate satisfaction and recommendations for improvement.

Methods:

Ten Dialysafe hemodialysis centers were assigned to patient activation, and all eligible English-speaking patients were invited. The intervention included 5 tablet-based educational modules and 5 corresponding videoconference peer mentoring sessions. Analyses integrated electronic health record demographic and clinical data, intervention-platform usage data, postintervention surveys, and qualitative notes from clinic Operations Committee meetings. A weighted engagement score ranging from 0-50 summarized completion of mentoring sessions, goal-setting, videos, quizzes, and patient stories, with greater weight assigned to the more interactive mentoring and goal-setting elements. Descriptive statistics, t-tests, chi-square tests and regression models assessed recruitment, completion (defined as completing all 5 mentoring sessions), and engagement. Qualitative data were inductively coded in NVivo and integrated with quantitative findings via joint displays.

Results:

Approximately one-quarter (155/639, 24.3%) of eligible patients were recruited to the intervention. Recruitment was more likely among younger, college-educated patients and those with sleep disorders. Of recruited patients, 46.5% (72/155) met with a peer mentor at least once. The average engagement score was 18.37 out of 50 possible points. Overall engagement was higher among men, Black patients, patients newer to dialysis, and those with more comorbidities. Attrition was concentrated before mentoring sessions began, and younger age and more comorbidities predicted completion. Communication with the care team was the most frequently patient-selected behavior change goal and the most frequently identified behavior change. Both mentees and mentors identified peer mentoring sessions as the most valuable part of the intervention, and both were highly satisfied with the intervention activities.

Conclusions:

Participants in the patient activation intervention were a self-selecting group who likely were already more engaged in their care than others in their clinics. However, that “communication with care team” was the most frequently selected health behavior goal and health behavior change demonstrates the importance and challenge of patient-clinician communication, even among highly activated patients. Mentees and mentors described the mentoring relationship as a highlight of the intervention. Digital patient activation interventions using peer mentoring may promote personal connection and improvements in communication with healthcare providers among the dialysis patient population, though reach is limited. Clinical Trial: ClinicalTrials.gov NCT03171545